Citation
A comparison of the differential effects of four aversive procedures utilizing electric shock on smoking behavior

Material Information

Title:
A comparison of the differential effects of four aversive procedures utilizing electric shock on smoking behavior
Creator:
Stokols, Michael Samuel, 1938-
Publication Date:
Copyright Date:
1968
Language:
English
Physical Description:
v, 87 leaves : illus. ; 28 cm.

Subjects

Subjects / Keywords:
Alcoholism ( jstor )
Analysis of variance ( jstor )
Behavior therapy ( jstor )
Clinical psychology ( jstor )
Control groups ( jstor )
Experimental procedures ( jstor )
Learning ( jstor )
Mental stimulation ( jstor )
Paradigms ( jstor )
Termination shock ( jstor )
Aversive stimuli ( lcsh )
Dissertations, Academic -- Psychology -- UF ( lcsh )
Psychology thesis Ph. D ( lcsh )
Smoking ( lcsh )
Genre:
bibliography ( marcgt )
non-fiction ( marcgt )

Notes

Thesis:
Thesis - University of Florida.
Bibliography:
Bibliography: leaves 81-86.
Additional Physical Form:
Also available on World Wide Web
General Note:
Manuscript copy.
General Note:
Vita.

Record Information

Source Institution:
University of Florida
Holding Location:
University of Florida
Rights Management:
Copyright [name of dissertation author]. Permission granted to the University of Florida to digitize, archive and distribute this item for non-profit research and educational purposes. Any reuse of this item in excess of fair use or other copyright exemptions requires permission of the copyright holder.
Resource Identifier:
021892845 ( AlephBibNum )
13418863 ( OCLC )
ACX9473 ( NOTIS )

Downloads

This item has the following downloads:


Full Text













A COMPARISON OF THE DIFFERENTIAL
EFFECTS OF FOUR AVERSIVE PROCEDURES
UTILIZING ELECTRIC SHOCK ON
SMOKING BEHAVIOR









By

MICHAEL SAMUEL STOKOLS


A DISSERTATION PRESENTED TO TILE GRADUATE COUNCIL OF
THE UNIVERSITY OF FLORIDA
IN PARTIAL FULFILLMENT OF THE REQUIREMENTS FOR THE
DEGREE OF DOCTOR OF PHILOSOPHY










UNIVERSITY OF FLORIDA
1968













ACKNOWLEDGMENTS

I would like to express my deep appreciation to the

Chairman of my Dissertation Committee, Dr. William Wolking, for

his encouragement, understanding, and valuable assistance during

the completion of this research. I would also like to convey

my thanks to the other members of my committee, Drs. Henry

Pennypacker, Hugh Davis, Paul Satz, and Ellsworth Bourque,

for their valuable help and advice. A special note of gratitude

is also due Dr. Roy Brener, Chief, Psychology Service, and the

Research Council of the Edward G. Hines Veterans Administration

Hospital, Hines, Illinois, for granting me the necessary research

time and facilities for the apparatus construction and data

collection phases of this investigation. Finally, I would like

to thank the men and women--for the most part, staff members at

Hines--who participated as subjects in this study.










TABLE OF CONTENTS




ACKNOWLEDGMENTS . . . . . . . . . .


LIST OF TABLES . . . . . . . . . . .

LIST OF FIGURES . . . . . . . . . .


Chapter


I. INTRODUCTION . . . . . . . . .

A Formulation of the Problem . . . .
Punishment and the Clinical Literature. . .
The Problem Behavior: Smoking . . . .
The Hypotheses Under Investigation. . . .


II. METHOD . .


Subjects.
Apparatus .
Procedures.


III. RESULTS. . .


IV. DISCUSSION .


Confounding
Situational
founding
Some Issues


V. SUMMARY. . .


APPENDICES . . .


REFERENCES . . .

BIOGRAPHICAL SKETCH. .


. Function of the Proced .







iables as a Source of Con-


Future Research . . . .


. . . . . . . .


. . . . . . . .


. . . . . . . .


. . . . . .* . .


Page


ii


iv


v








LIST OF TABLES


Table La__

I. Stimulus Items, Shock Points, and Representative
Escape Responses. .. ...... . . . .. . 37

2. Repeated Measurements Analysis of Variance of the
MPSR Scores Across Session-Days--Groups HI, H2,
and H3 N = 24. . . . . . . . . . 48

3. Neuman-Keuls Test of all Ordered Pairs of Session-
Day Means for Groups HI, H2, and H3 . . ... 50

4. Repeated Measurements Analysis of Variance of the
MPSR Scores Across Session-Days--Groups HI, 1H2,
H3, and H4 N = 32 . . . . . . . . 51

5. Analysis of Variance of the MPSR Scores on the 15th
Session-Day--Groups HI, H2, and H3 N = 24 ..... 52

6. Analysis of Variance of the MPSR Scores on the 15th
Session-Day--Groups HI, H2, H3, and H4 N = 32. 53

7. Repeated Measurements Analysis of Variance of the
MPSR Scores Two, Six, and 12 Weeks After
Treatment Termination--Groups HI, H2, H3, and H4
N = 32. . . . . . . . . ... . .. 54

8. Neuman-Keuls Test of all Ordered Pairs of Follow-
Up Means for Groups HI, H2, H3, and H4. . . .. 55

9. Analysis of Variance of Age--Groups HI, H2, 13,
and H4 N = 32. . . . . . . . . .. 77

10. Analysis of Variance of the Pre-Treatment Mean
Number of Cigarets Smoked per Day--Groups H1, H2, H3,
and H4 N = 32. . . . . . . . . ... 77

11. Analysis of Variance of the Number of Years A
Cigaret Smoker--Groups HI, H2, H3, and H4 N = 32 77

12. Per Cent Smoking Reduction Scores Across Experi-
mental Treatment and Follow-Up Periods--All Ss. . 78

13. Three-Day Means for Each S Compiled from the Actual
Numbers of Cigarets Smoked Before Treatment and at
the End of Follow-Up. . . . . .. . 80















LIST OF FIGURES


Figure Page

1. HI, H2, 113, and H4 Group MPSR Scores Across the
Experimental Treatment and Follow'-Up Periods . 47















CHAPTER I

INTRODUCTION

While punishment training has been the least utilized

behavior therapy method to date, a review of the recent lit-

erature does indicate that this method, often referred to as

aversive conditioning, is finding increased favor among be-

havior modifiers. Nevertheless, many clinicians of varied

theoretical persuasions continue to doubt the effectiveness

of punishment training, viewing its use in clinical situations

with serious misgivings. The reasons underlying such attitudes

are numerous, and several likely ones will be mentioned here.

Before proceeding, however, a definition of punishment,

as it pertains to this study, is in order. Punishment, then,

has been defined as: (1) some physically aversive or noxious

stimulus which is either contiguous with a CS, or contingent

upon the performance of some behavior (Church, 1963); and (2) a

stimulus which a subject (S) will reject if given a choice be-

tween it and no stimulus at all (Solomon, 1964). Thus, such

procedures as, e.g., verbal disapproval, restraint, the with-

holding of positive reinforcement, time-outs, or massed practice,

while they may properly fall under the general rubric of negative

reinforcement, will not be considered punishment in this nar-

rower sense.









As Solomon (1964) has pointed out, a large number of

clinicians undoubtedly feel that punishment just does not work;

that its effects are transient, unstable, inconsistent, and do

not really weaken habits. The therapist who has his doubts

about the effectiveness of punishment is in good company. Many

prominent psychologists have disavowed punishment as having

any lasting suppressive effects on behavior (e.g., Bandura,

1962; Estes, 1944; Skinner, 1948, 1953; Thorndike, 1932). Many

writers and editors of texts dealing with the areas of learning

and conditioning devote but a few lines to the problem of pun-

ishment (e.g., Hull, 1951; Kimble, 1961; Woodworth and Schlos-

berg, 1958). Solomon points out that many contemporary intro-

ductory psychology texts devote scant space to punishment as a

scientific problem, citing as a case in point George Miller's

recent text, Psychology, the Science of Mental Life, which con-

tains no discussion of punishment anywhere.

The state of the experimental learning literature is in

itself most confusing, and undoubtedly contributes in no small

measure to the negative feelings many clinicians hold towards the

use of punishment in clinical situations. While much experi-

mental evidence indicates that punishment decreases the prob-

ability of a response occurring, contrary experimental results,

often referred to as "paradoxical effects," are legion (refer

to articles by Church, 1963; Kushner and Sandler, 1966; Martin,

1963; Sandler, 1964; and Solomon, 1964). For example, several

studies have shown that when punishment is correlated with

positive reinforcement during acquisition trials, punishment-









extinction trials produce an increase in responding over con-

ditions of regular extinction; also, there is usually increased

resistance to extinction (Carlsmith, mentioned by Solomon, 1964;

Holz and Azrin, 1961, 1962; Martin and Ross, 1964). Karsh (1962)

found that punishment, if introduced before the asymptotic

performance under regular training has been reached, may well

induce further improvement under the punishment procedure.

Azrin (1959, 1960) found that when mild punishment of an in-

strumental response acquired under positive reinforcement is

terminated, there is often a temporary increase in response rate

over that which would have occurred without punishment. Several

researchers have reported that increased learning in selective

learning situations often obtains when "right" responses are

punished (Muenzinger et al., 1938; Muenzinger and Powloski,

1951; Prince, 1956). And, there have been studies showing

that, under certain conditions, Ss prefer continued exposure

to punishment, even though non-punishing alternatives are

available (Brown et al., 1964; Sandler, 1964). While many

more examples could be given, perhaps Church (1963) best summed

up the "paradoxical" literature with his observation that

punishment, under particular circumstances, might result in

almost any conceivable effect.

Solomon (1964) also suggests that the fear of unwanted

emotional side effects, often produced in the laboratory, has

probably deterred many therapists from making use of punishment

procedures. Many animal studies have, in fact, produced highly

disturbed Ss (e.g., Brady's f1958] work with ulcerous








monkeys; Gantt's [19443 work with neurotic dogs; Maier's

[19493 work with fixated rats; Masserman's [1943] work with

neurotic cats and monkeys; and Masserman and Pectel's [19533

work with monkeys). Among others, such factors as high stimulus

intensities, the punishment of consummatory and instinctive

behavior, punishment under non-discriminatory control, the un-

avoidability of punishment, and the punishment of responses

acquired under negative reinforcement all seem to contribute

towards such results.

Finally, but perhaps most importantly, the often am-

biguous and inconclusive results of many of the published

clinical studies and case reports using punishment as the

treatment variable have, in all probability, discouraged many

therapists from making use of punishment training procedures.

Before turning to relevant examples of this literature, how-

ever, the major focus of this study will first be considered.

A Formulation of the Problem

In the majority of the clinical cases which have

utilized a punishment paradigm, the major underlying assump-

tion seems to have been the following: that the simple pair-

ing of a short-duration noxious stimulus with either a pre-

senting stimulus (the CS) or an elicited response would be

sufficient to insure the subsequent lasting suppression of the

target behavior in question. Ihile the emphasis seems to have

been focused on the problem of obtaining response suppression

-- i.e., getting the patient not to do something -- relatively








little experimental literature is available concerning the

problem facing the clinician of systematically getting the

patient to do something else instead. This issue is certainly

familiar to the laboratory investigator studying escape and

avoidance learning. In such experiments the design usually

provides for the development of alternative instrumental

escape and avoidance behaviors as a way of averting or atten-

uating the noxious stimulus.

Solomon (1964) has stated: "Punishment becomes ex-

tremely effective when the response-suppression period is

tactically used as an aid to the reinforcement of new re-

sponses that are topographically incompatible with the punished

one" (p. 241). One way to achieve this end would be to use the

noxious stimulus itself as a reinforcer for new behavior

judged to be incompatible with the punished response. If

cessation of shock is made contingent upon the occurrence of an

operant, this escape response will be reinforced. Soon, escape

and then avoidance responses should be occurring in stable

fashion immediately upon presentation of the stimulus patterns)

which formerly elicited the punished response. Mowrer (1960)

calls such learning "active avoidance learning" and presents

several examples illustrating this paradigm in his book,

Learning Theory and Behavior.

Turner and Solomon (1962) using human Ss, and electric

shock as the UCS, showed the effectiveness of making ces-

sation of long-duration shock contingent upon deliberate,








voluntary operants (as opposed to short-latency reflexive re-

sponses) for escape and avoidance learning. Of course, the

behavior therapist is primarily concerned with the suppression

of unwanted behavior, and Turner and Solomon did not concern

themselves with response suppression, per se, in their mono-

graph. However, it could reasonably be expected that by combining

in treatment what the behavior therapist employing punishment

training attempts to do -- that is, foster response inhibition

as a result of the negative conditioned emotional response

which develops when punishment is made contingent upon a

response -- with what Solomon (1964) suggests be done -- that

is, sequentially reinforce an operant response incompatible

with the punished response -- far more effective and longer

lasting response suppression should occur.

While this procedure is well known in the experimental

literature, many clinicians have either ignored such an approach,

or have made relatively little systematic use of this tactic in

their treatment of patients. This has been especially true in

the many instances where drugs have been employed as the avers-

sive stimulus. A major intent of this study, then, will be the

attempt to demonstrate clinically whether a long-duration

noxious stimulus employed in the manner suggested above would,

in fact, be more effective in inducing lasting response sup-

pression than the same stimulus of short duration simply paired

with the target response, or the CS(s) eliciting such behavior.

And, the experimental learning and conditioning findings

have also overwhelmingly indicated that non-contingent or randomly









administered stimuli -- either positive or negative -- have

little lasting suppressive or facilitative effects on behavior.

All clinical attempts utilizing aversive conditioning methods

have at least assumed this much in the design of the treatment

procedures. To this end, then, the attempt to demonstrate that

a short-duration noxious stimulus presented randomly would not

have any lasting suppressive effect on a given response pattern,

will also be made. The results of such a demonstration should

establish a more meaningful base from which to view the data

obtained from the above mentioned comparison.

Punishment and the Clinical Literature

Choice of the Noxious Stimulus

By far, the majority of the published aversive condi-

tioning studies have concerned themselves with the treatment of

alcoholism and the sexual deviations. In most cases the aver-

sive stimulus has been an emetic drug such as apomorphine or

emetine, and, by and large, conditioning principles have been

violated in many instances (Eysenck, 1963; Franks, 1958, 1963;

Rachman, 1965). Apparently some clinicians have given the

patient alcohol (the CS) after the patient reached the height

of nausea (backward conditioning), time intervals between pre-

sentation of the various stimuli have not been controlled, and

the nausea-inducing drugs may have acted as central depressants,

thereby possibly interfering with the acquisition of the condi-

tioned responses (Eysenck and Rachman, 1965). Others have

focused on the act of vomiting rather than the feeling of nausea

as the CS, and individual reactivity to the drugs has been a








confounding factor (Barker et al., 1961).

Sanderson (1963) notes that the reaction to apomor-

phine is too gradual and too irregular to meet the requirements of

a good UCS. Also, the use of emetic drugs as aversive stimuli

is: (1) cumbersome and messy; (2) involves undue man-hours,

expense, and effort; and (3) often necessitates the taking

of exacting medical precautions including hospitalization

to insure the safety of the patient (Rachman, 1965). Cases

in point are the studies of Clark (1963), who treated a case

of fetishism; Sanderson et al., who treated alcoholics (reported

in Franks, 1964); Raymond (1956), who treated a case of hand-

bag fetishism and perambulator destruction; Cooper (1963), who

treated a case of impotence and fetishism; and Barker (1965)

and Barker et al. (1961), who treated cases of transvestism.

Cooper's paper in particular dramatically points out the degree

to which patients undergoing this kind of treatment are physically

debilitated, fatigued, and endangered.

Thus, in this study, electric shock was used as the

noxious stimulus of choice. Not only can electrical stimula-

tion be more precisely controlled, it can be delivered at a

determined intensity for an exact duration of time at precisely

the required moment. And, not only does electric stimulation

avoid many of the disadvantages of the emetics listed above,

it has the added advantages of not requiring medical supervision

nor more than one person in its administration (Barker, 1965;

McGuire and Vallance, 1964; Rachman, 1965). Further, from the








personal clinical experience of E with this method, and from ex--

perience directly related to this study, it has been observed

that, while most patients or Ss have not liked the experi-

ence of getting shocked, none exhibited intense fear reactions

or immobilization to the procedure. And, lastly, the vast major-

ity of the studies in the experimental punishment literature have

used electric shock as the aversive stimulus, thus providing the

clinician with a wealth of potentially valuable experimental

data. Thus, only aversive conditioning studies which have em-

ployed shock as the noxious stimulus will be mentioned here.

Clinical Studies Using Electric Shock

Thorpe et al. (1963) administered shock to a homosexual

patient through a grid on the floor after two non-aversive pro-

cedures with the same patient had failed to bring about any

change in his behavior. Using a VI/VR reinforcement schedule,

shock, presumably of short duration, closely followed the

illumination of a photograph of a nude male on approximately one

quarter of the presentations. The patient received a total

of 100 trials, each consisting of 40 illuminations. Follow-up

apparently showed that, at best, the patient could be considered

bisexual rather than exclusively homosexual. Using essentially

the same procedure with another homosexual, Thorpe and Schmidt

(1963) reported in the same volume that the patient terminated

treatment after three sessions over two days. This case was

deemed a failure.

McGuire and Vallance (1964), also following a simple

punishment model, reported treating cases involving fetishism,








smoking, writer's cramp obsessional ruminations, and alcoholism.

They indicated that just over 50 per cent of these patients

(N = 39) improved sufficiently to receive a "good improvement"

or "symptom removed" rating at the end of treatment. Apparently,

the authors encouraged their patients to administer their own

shock, both during treatment sessions and at home.

Mees (1966) recently reported in great detail the treat-

ment of a case of sadistic fantasies in a 19-year-old male.

After 25 weeks of baseline data collection, short-duration shock

was delivered to the fingers when the patient imagined selected

parts of his fantasy. Over 6,000 shocks during 65 sessions

were given during the 14-week treatment period. Follow-up 11

weeks later indicated that the patient's sadistic fantasies

accompanying masturbation had markedly decreased and that

heterosexual fantasies were increasing. Like the patients of

McGuire and Vallance above, Mees' patient began shocking him-

self during the second week of punishment training, sometimes

for periods up to two hours. Wolpe (1965) also reported that

a physician with drug addiction of three years' standing was

able to "significantly reduce" his cravings with only nine

"distinctly strong" shocks which were self-administered over

approximately a three-week period. Three months later, however,

there was a complete relapse and drug taking resumed unabated.

Feldian (1966) criticizes the procedure of allowing the subject

to shock himself on the grounds that punishment may become

sought after; i.e., may become positively reinforcing, especially








if the patient is free to set his own intensity level.

Sandler's (1964) concept of masochism, defined as the situation

in which a noxious stimulus does not result in avoidance be-

havior being exhibited by the S receiving it, might also be

relevant here.

Kushner (1965), and Kushner and Sandler (1966), refer to

a fetishist who was treated along simple punishment lines, for

the most part. Shock of short duration was paired with the

patient's images of himself engaging in various aspects of his

fetishist activity, presentation of the fetishist object

(woman's panties), and the presentation of a sexually arousing

picture. An 18-month follow-up showed the patient to be

essentially free of his fetishist behavior. The latter study

(Kushner and Sandler, 1966) also reported the treatment of an

obsessive suicidal ruminator, an occupational compulsive hand

contractor, and an exhibitionist with short-duration shock.

Follow-up (12 months) indicated complete suppression of the

exhibitionist activity, moderate success in the case of the

suicidal ruminator (three-month follow-up), and little if any

improvement on the job after 101 shock sessions for the hand

contractor. The last-mentioned patient's teletypewriter per-

formance was much improved during treatment sessions, however.

Thorpe et al. (1964) used a technique which they called

"aversion relief therapy" in treating three "homosexuals" (two

were called latent), one fetishist, one phobic, one obsessive-

compulsive, and one depressive compulsive eater. Using 24








words on a disc appropriate to each patient's problem as the CSs,

they presented each word in turn, pairing it with short-dura-

tion shock to the feet. The last word -- e.g., in the case of

a homosexual it might be "heterosexual" -- was not shocked and

thus was the "relief" word, as it signaled the end of the trial.

While results of this study were ambiguous as presented, all the

patients seemed to be improved to some degree immediately

following treatment, with the exception of the obsessive-com-

pulsive and the compulsive overeater. Both of these patients

terminated treatment. Since only very brief follow-ups were

given, little can be said about the efficacy of this particular

brand of punishment training.

Meyer and Crisp (1964) reported treating two obese women

with shock, but the exact procedures are anything but clear.

Certain foods were displayed in the same room with the patient,

and shock was contingent upon actual movement by the patient

towards the "temptation" food. The shocks ceased when the

patient ceased moving towards the food, and apparently could

be avoided entirely during any given session. The authors

report one success and one failure but leave unanswered ques-

tions pertaining to, e.g., shock duration and number, whether

the reinforcement contingency was completely controlled by the

S, whether gross movement toward the "temptation" food was the

only experimental response focused on, or how much time the

patients spent in the treatment rooms.

Through the use of short-duration response-contingent

shock (onset sometimes delayed up to 30 seconds, though) Tate








and Baroff (1966) deconditioned acute self-injurious behavior

(SIB) in a hospitalized psychotic boy over a period of five

months. Eventually, just the threat of shock was sufficient to

produce a reduction in other unwanted behavior such as postur-

ing and not eating. Withdrawal of physical contact ("time-

out") was previously used as the negative reinforcement, but

shock was found to be far more effective in suppressing the

unwanted behavior. The authors refer to a paper read by Lovaas

et al., and a personal communication by Ball, all of whom used

similar shock procedures to successfully suppress SIB in

several schizophrenic children and a severely retarded girl,

respectively.

Bancroft et al. (1966) recently reported treating a

pedophiliac with electric shock over a 38-day period. Briefly,

the patient was told to concentrate on sexually stimulating

fantasies after viewing pictures of children. When an

erectile response occurred, which registered on a specially

constructed transducer, shock was administered to his arm.

Once in every four trials, the shock box was disconnected, and

the patient was given pictures of adult women and encouraged

to produce an erection with heterosexual fantasies. After an

18-month follow-up period, the patient continued to display a

variety of sexual difficulties although pedophilia was no

longer the major problem.

Hsu (1965) placed a tray containing six one-ounce

plastic cups filled with beer, wine, whiskey, milk, water,

and fruit juice in front of alcoholic patients, and then as








each alcoholic drink was swallowed, an electric shock, 30

seconds in duration, was administered. After completion of

the five-day treatment sequence, the patient was released

from the hospital with the provision that he return for two-

day booster treatments at four-week and six-month intervals.

The results of this treatment procedure were ambiguous.

First, Hsu used "out of the hospital working or seeking employ-

ment" as the criterion measure for treatment effectiveness, not

the decrease or absence of further drinking behavior. Secondly,

Hsu failed to provide clear-cut follow-up data. It was simply

reported that of 40 patients who received treatment, 20 failed

to complete the initial five-day sequence or the first rein-

forcement booster treatment. The other 20 patients did at

least get that far, and of these, 13 were simply described as

being "out of the hospital working or seeking employment."

There were other puzzling aspects to this study. Hsu's place-

ment of the electrodes above both ears of his patients was, to

say the least, atypical and without precedent or subsequent

imitation in the recent aversive conditioning literature. The

patients' reactions to the shock stimulus were also atypically

severe. Many patients exhibited marked physical responses such

as foot stamping, hand trembling, crying and screaming, nausea

and vomiting. Others reported feeling head pain and seeing

"flashing lights." Finally, the duration of the shock -- 30

seconds -- was not explained on theoretical or empirical grounds,

and shock cessation was not contingent upon any particular re-

sponse or stimulus event.








Very few of the aversive procedures cited in the

foregoing case reports have seemed to be rooted very deeply

or systematically in the general body of the experimental

psychology of learning. Certainly none of these papers sys-

tematically provided for the development of alternative and

more desirable escape and avoidance behavior by utilizing the

positive reinforcing effects of response-contingent shock

cessation. Several studies employing shock as the noxious

stimulus have, however, evidenced their greater awareness of

these procedural considerations, and to these attention will

now be turned.

Blake (1965), working with some 50 to 60 fee-paying

alcoholics, has attempted to test the efficacy of "straight"

aversive conditioning against the same aversive procedures

following deep muscle relaxation training. Blake argued that

because alcoholic behavior is often motivated and accompanied

by high drive (anxiety or fear), the effects of aversive con-

ditioning would be enhanced if the S could approach the treat-

ment situation in a state of low drive. Also, motivational

efforts would be more effective while the patient was deeply

relaxed.

In a recent paper, Blake (1967) has published 12-

month follow-up data for both groups. The results show that

59 per cent of the relaxation-aversive group (N = 37) and 50

per cent of the straight aversive group (N = 25) were classified

as either "abstinent" or "improved." The difference is not

statistically significant though. Of major interest for the








present study, however, was the aversive procedure used by

Blake which incorporated escape from shock. Ss were given the

necessary ingredients to mix a drink according to taste, and

then were shocked on a 50 per cent reinforcement schedule

as they sipped (without swallowing) the liquid, presumably

on command. Shock could be terminated by spitting out the

alcohol. On non-reinforced trials, the alcohol was ejected

in response to a light signal. The number of conditioning

sessions was not controlled, and they varied over a four-to

eight-day period.

In reviewing the various forms of punishment training

in the aversive conditioning literature, Feldman and MacCulloch

(1965) concluded that anticipatory avoidance learning -- a

situation wherein the S can prevent the occurrence of the

noxious stimulus (the UCS) by performing an instrumental re-

sponse to the CS -- was particularly resistant to extinction.

Support for this position, as mentioned previously, has been

amply demonstrated by Solomon and Wynne (1953), Turner and

Solomon (1962), and Solomon (1964).

In their work with homosexuals, Feldman and MacCulloch

constructed two hierarchies, one comprising slides of nude and

clothed males in ascending order of attractiveness, and the

other of females in the reverse order of attractiveness.

Briefly, a male slide (starting with the least attractive) was

presented on a screen, and if the S did not switch off

the slide within eight seconds, he received a shock. The







shock stimulus was terminated when the illuminated slide was

finally switched off. Introduction of the appropriate female

slide (initially, the most attractive) was made contiguous

with the removal of the male side on many trials. The thera-

pist controlled the removal of the female slide, but the S

could ask for its return. This request, randomly met by the

therapist, was increasingly made, as the presence of the female

slide acted to delay the reappearance of a male slide. About

30 trials per session were given, but the number of sessions

varied from five to 28. "Booster" sessions were also ad-

ministered during the follow-up period.

Of 19 homosexuals treated at the time of publication,

three failed to complete the procedures, six showed little, if

any, improvement, and ten have altered their sexual orientation

to some clinically significant degree. Follow-ups ranged from

one month to 14 months.

Most interestingly, MacCulloch et al. (1966), using the

same methodology as that described above for Feldman and Mac-

Culloch, treated four alcoholics, all of whom returned to their

previous drinking behavior following treatment. In assessing

these failures, the authors questioned whether their patients'

drinking behavior was any longer amenable to psychological

control, due to the possible development of a pathological

biochemical necessity for alcohol. It should be noted, how-

ever, that motor, gustatory, and olfactory components of the

drinking response -- e.g., sipping, tasting, and smelling the








alcohol -- were not shocked as part of treatment, as occurred

in Blake's (1965) procedures with alcoholics. Instead, Mac-

Culloch et al. relied almost entirely on visual stimuli such as

slides of alcohol, and alcohol in a bottle and a glass in the

S's visual field. And, in like vein, it might be hypothesized

that Feldman and MacCulloch's moderate success with homosexuals

may have been occasioned by the very fact that the visual-

perceptual mode plays a more vital part in the arousal and pre-

cipitation of homosexual behavior than it does for alcoholic

behavior.

In summary, then, the case reports and studies mentioned

so far have all used electrical stimulation as the noxious

stimulus, and all have attempted to suppress some undesirable or

unacceptable behavior-complex judged to be the result of mal-

adaptive learning. In addition, a relative few have attempted

to reinforce alternative behavior deemed incompatible with, and

preferable to, the punished behavior -- at least to some degree.

Beyond this, little in the way of comparison can be said.

Various rationales and justifications purportedly based on ex-

perimental evidence have been offered, as well as a variety of

classical and instrumental punishment procedures -- some simple

and some more complex. Treatment intensities, controls, and

lengths have varied. The patients and their behavioral syn-

dromes, as well as treatment results, and follow-up procedures

and lengths are not comparable. Often, follow-up data have

not been offered at all. Rachman's (1965) Table 1 shows, for

example, that of 114 persons reported in the literature who








were treated with aversive conditioning procedures using

electric shock for a variety of behavior disorders, 40 per

cent were not followed past treatment termination.

Most importantly, :-o:.-.-.r, the clinical literature

offers little, if any, evidence bearing on the issue of

whether the reinforcement of an appropriate escape response

through long-duration electric shock cessation is more effective

in establishing lasting behavior suppression than short-duration

shock which is simply contiguous with a CS or target response.

And, in no study to date has the noxious stimulus been adminis-

tered in completely random fashion, either for control or

treatment purposes.

With the above in mind, and before proceeding with a more

formal statement of the hypotheses under investigation,

attention will first be turned to the specific behavior syn-

drome dealt with in this study.

The Problem Behavior: Smoking

The target behavior selected for deconditioning was

cigaret smoking. This habit appeared to be a satisfactory

compromise between using a behavior syndrome of full clinical

proportions such as alcoholism, with all the attendant prob-

lems for S selection, experimental control, and treatment

which would have been entailed, and a non-clinical contrived

response such as lever pressing which could have been

conditioned before punishment training began. With a target

response such as lever pressing, generalizability of results

to clinical situations and problems would have been limited.









Koenig and Masters (1965) list three criteria which

should be satisfied in selecting a behavior for clinical ex-

perimentation:

1. The behavior should have the characteristic of
maladaptiveness to keep within the paradigm of
neurotic behavior.

2. The behavior must be potentially observable
and occur in discriminable units.

3. The behavior should ideally occur with a
fairly high frequency in the population at
large.

Cigaret smoking appears to satisfy all three. It is

an entrenched habit that has proved to be extremely difficult

to modify for many smokers. The smoker is constantly being

urged to maintain his habit by virtue of the massive and

ubiquitous advertisement campaigns the cigaret manufacturers

conduct. Smoking is socially acceptable, and the health-

hazard issue raised by numerous investigations -- in particular,

the Surgeon General's report (Smoking and Health, 1964) --

linking cigaret smoking with lung cancer and a variety of other

disease states, has apparently proven to be an insufficient

deterrent. Hammond and Percy (1958) found that of 333 ex-

smokers identified in a random telephone directory sample of

3,560 smokers and ex-smokers, only 8.7 per cent had quit be-

cause of health concerns. However, 62.5 per cent of the ex-

smokers had given up the habit because of some condition, such

as coughing or throat irritation, made worse by smoking.

Apparently, the threat of lung cancer or some other disease,

while seemingly a most powerful deterrent, is too far removed








in time as a consequence of smoking to be a very effective

negative reinforcer.

A great deal of effort has been expended investi-

gating the psychological characteristics of smokers and

non-smokers. As an illustration of this research activity,

Fine et al. (1966) recently compiled a bibliography on the

psychological aspects of smoking consisting of 143 studies

conducted from January 1940 through September 1965. Matterazzo

and Saslow (1960), in their extensive review of the literature,

found that while smokers -- particularly heavy smokers -- and

non-smokers differed on some 30 variables, none of the studies

offered a single variable found exclusively in one group but

absent in the other. The authors concluded that smokers seem

to be slightly more neurotic, on the average, than non-smokers.

At the individual level, however, this statistical relationship

is meaningless. Also, they concluded, a clear-cut smoker's

personality has yet to be found.

Much research has been aimed at modifying this physio-

logical habit by substituting lobeline, a drug which produces

the effects of nicotine, for nicotine (British Tuberculosis

Association, 1963; Goodman and Gilman, 1960). The inconclusive

results of lobeline studies indicate the probability that there

is a more compelling component in smoking than mere physiologi-

cal addiction, if in fact there is any such addiction involved.

Cigaret smoking has also been the subject of a number

of behavior therapy studies. Several have focused attention









on a comparison of the relative effectiveness of divergent

treatment forms, and at least two of these have included an

aversive conditioning procedure as one of the treatment methods.

Koenig and Masters (1965), using seven therapists and 42 Ss

between the ages of 19 and 23, compared the effectiveness of

systematic desensitization, supportive counseling, and aver-

sive conditioning methods. The aversive conditioning procedure

consisted of short-duration shock administered to the S's

fingers as he proceeded to smoke two cigarets during the treat-

ment session. All Ss received nine treatment sessions over a

five-week span. While no significant treatment or inter-

actional differences were found at the end of this period,

significant therapist differences (p < .05) were delineated.

The groups showed a significant decrease in smoking consump-

tion from pre-treatment levels (52 per cent reduction; p < .001);

six months later, the mean per cent reduction score had dropped

to 19 per cent.

Ober (1967) compared the results of a "self-control"

group, an aversive conditioning group, one which received treat-

ment based on transactional analysis concepts and methods,

and a no-treatment control group. The Ss in the aversive condi-

tioning group were instructed to self-administer shocks with a

portable battery-operated shocker whenever they experienced the

desire for a cigaret. Sixty Ss (college students) and two

therapists were used. The Ss were seen for ten 50-minute group

sessions over a four-week period. At termination of treatment








and after a one-month follow-up, all treatment conditions were

significantly lower than the no-treatment control group (p < .001).

Presumably, the cigaret consumption reduction rates for the ex-

perimental groups were also significantly lower than their pre-

treatment rates after treatment, although this is not ex-

plicitly stated. Following treatment, the per cent reduction

rates were 81, 100, and 52 per cent for the self-control,

aversive, and transactional groups, respectively. One month

later, these rates were 49, 58, and 57 per cent, respectively.

The no-treatment control group showed a 3 per cent reduction in

smoking following treatment. No significant treatment, thera-

pist, or interactional differences were found, however.

Pyke et al. (1966) compared the results of one group

receiving desensitization training, combined with regular group

discussions on the ills of smoking, the viewing of films, and

the reading of anti-smoking literature, with two control groups

whose members merely kept frequency counts of their smoking

consumption. The first control group Ss monitored their

smoking for eight successive weeks, and the second kept fre-

quency counts only during the first and eighth weeks. The

experimental group Ss attended one group meeting and one private

session each week for ten successive weeks. Fifty-five paid

Ss, all college students, participated in the study, and a

stated "desire to stop smoking" was the only selection criterion

used. Apparently many, if not most, of the Ss smoked less than

20 cigarets per day prior to their participation. The results

after eight weeks clearly favored the experimental group over










the two control groups (p < .01), although little else can be

definitely said with respect to the treatment procedures be-

cause of the potpourri of methods used. The follow-up data

offered for the experimental group, while indicating some

lasting effects of treatment over several weeks, were of question-

able value as one third of the Ss in this group were not in-

cluded. No follow-up data for the control groups were pre-

sented.

Other aversive stimuli have been used in an effort

to decondition cigaret smoking. Wilde (1964) and Franks

et al. (1966) used a mixture of smoke and hot air as the

noxious UCS, and cessation of this gaseous mixture was made

contingent on the escape response of snuffing out the cigaret.

In the first case, Wilde treated seven Ss, between the ages of

25 and 54, all of whom smoked at least 20 cigarets daily.

Three stopped smoking completely after two treatment sessions

in two days. One was down to two cigarets per day after a single

session, and another S changed over to a pipe after 20

sessions. Two others discontinued treatment and no mention

was made of their progress, if any, or the number of treatment

sessions received. No follow-up information was offered for any

of the Ss. Franks et al. began treatment with 23 adult

Ss but only nine completed the prescribed course -- 12 condi-

tioning sessions within a four-week period. Of these nine,

follow-up one-half year later revealed that four were not

smoking, one was smoking "less", two were smoking as much as








ever, and one had switched to a pipe. The ninth S was not

heard from. The authors did not include the smoking rates

for any of the Ss immediately following treatment termination.

And, finally, Greene (1964) attempted to reduce the

smoking rate of mental retardates in a free-operant situation

with the use of white noise, superimposed upon continuous

music, as the negative reinforcement. A control group without

the superimposed white noise was also run. Twenty-one Ss,

ranging in age from 16.5 to 25.6 and with a mean I.Q. of 67.5,

were used, and each participated in five consecutive daily

sessions. The results showed that increased smoking rates

were obtained over pre-treatment levels for both the experi-

mental and control groups (p = .10, p <.05, respectively), and

these findings were attributed to the positive reinforcing

properties of barely audible clicking noises made by the relays.

A second control group was then run without the clicking noises,

and no change in smoking rates was found.

While the treatment procedures and methods of these

studies concerned with the suppression of cigaret smoking are

interesting and even innovative, they, like the studies re-

viewed earlier, offer little additional evidence bearing on the

issues of this study. With this in mind then, a statement of

the hypotheses investigated in this study is now in order.

The Hypotheses Under Investigation

Most of the clinical studies and case reports reviewed

in this chapter have employed aversive conditioning treatment

procedures based on a simple punishment model. That is, in








attempting to obtain the suppression of unwanted behavior, a

short-duration aversive stimulus has either been paired with

the appropriate CSs, and/or both the target responses themselves.

The prediction was made however (see pages 4- 7), that increased

and longer lasting behavior suppression would occur if patients

were, in addition, positively reinforced for the performance of

more desirable alternative instrumental acts incompatible with

the behavior being punished.

One way to accomplish this end in the clinical situation

would be to utilize an aversive conditioning procedure based

upon the experimentally familiar "escape" paradigm. Here, the

conditions governing the onset of the aversive stimulus would

be identical with those for a "simple punishment" procedure;

stimulus termination, however, would be made contingent upon

the performance of the appropriate escape response, thereby

serving to positively reinforce such instrumental acts.

A small number of the studies and clinical case reports

reviewed earlier (Blake, 1965; Feldman and MacCulloch, 1965;

MacCulloch et al., 1966) have attempted to utilize, with vary-

ing degrees of success, treatment procedures based upon such

an escape paradigm. A perusal of the clinical aversive con-

ditioning literature indicates, however, that a controlled

comparison of treatment procedures based upon the two punish-

ment models has yet to be attempted. The first two hypotheses

of this study, then, are concerned with this issue; whether, in

fact, a clinical aversive conditioning procedure based upon an








escape model will result in significantly greater or more

effective response suppression than one based upon the

"simple" punishment model.

Hypothesis 1 (HI) -- Ss presented with an ordered set

of stimulus items associated with, and related to cigaret

smoking, and subjected to short-duration electric shock con-

tiguous with the CS(s) or contingent upon the performance of

the target responsess, will evidence a statistically signifi-

cant reduction from pre-treatment levels in their mean cigaret

consumption rate on the last experimental treatment session-

day, as well as during the 12-week follow-up period.

Hypothesis 2 (H2) -- (1) Ss presented with the same

ordered set of stimulus items and shock onset conditions as

the HI Ss above, but in addition subjected to electric shock

which terminates only upon the performance of an appropriate

escape response pre-determined by E, will also evidence a

statistically significant reduction from pre-treatment levels

in their mean cigaret consumption rate on the last experimental

treatment session-day, as well as during the 12-week follow-up

period. (2) In addition it is predicted that this mean re-

duction in cigaret smoking will be significantly greater than

that for the HI Ss for the following: (a) during the course

of the experimental treatment period; (b) specifically on the

last experimental treatment session-day; and (c) during the

12-week follow-up period.

While the above hypotheses would appear to cover the

central issue underlying the conception of this study, one









further related consideration remains. As mentioned earlier,

the experimental learning and conditioning literature has

strongly indicated that, all other factors held constant,

reinforcement delivered in a purely random or "chance" fashion

has little lasting suppressive or facilitative effect on

subsequent performance. All the clinical attempts utilizing

aversive conditioning methods have at least assumed this much

in the design of the treatment procedures. Nevertheless, as

this experimentally derived finding has not been tested under

clinical treatment conditions using an aversive stimulus, such

as electric shock, it would seem appropriate, and even germane,

to do so here. The results of Ss run under random shock con-

ditions would offer a "base for comparison," putting the data

obtained under the two experimental treatment procedures

described above into a more meaningful perspective. Therefore,

the following hypothesis has been incorporated into this study.

Hypothesis 3 (H3) -- Ss presented with the same ordered

set of stimulus items as those under HI and H2, but subjected to

randomly administered electric shock of short duration, will not

evidence a statistically significant reduction from pre-treatment

levels, either on the last experimental treatment session-day,

or during the follow-up period.

Hypotheses HI, H2, and H3, then, constitute the major

hypotheses of this study.

Addendum


After the data collection phase of the study had








gotten under way, certain observations concerning the reactions

of the Ss to the daily shock session regime became apparent.

Several Ss, after completing approximately half of the experi-

mental treatment sessions, attempted to "buy" their way out of,

or otherwise attenuate their commitment to complete the sessions

yet remaining. These Ss, in essence, offered to more quickly

terminate or reduce their cigaret consumption if E in turn would

agree to eliminate some or all of the experimental treatment ses-

sions remaining to be run. This matter will be expanded upon in

the Discussion chapter. Accordingly, a fourth experimental group

was then run to test the hunches generated by these observations,

and the following hypothesis was included in the study.

Hypothesis 4 (H4) -- (1) Ss presented with the same ex-

perimental conditions as those under H2, but with the added pro-

vision that they can avoid completely the aversive conditioning

treatment session on any day within the treatment period immedi-

ately following a day free of cigaret smoking, will also evi-

dence a statistically significant reduction from pre-treatment

levels in their mean cigaret consumption rate on the last ex-

perimental treatment session-day, as well as during the 12-week

follow-up period. (2) In addition it is predicted that this mean

reduction in cigaret smoking will be significantly greater

than that for each of the other three groups for the following:

(a) during the course of the experimental treatment period;

(b) specifically on the last experimental treatment session-

day; and (c) during the 12-week follow-up period.

All references to significance in the above four

hypotheses refer to the .05 level of significance.















CHAPTER II

METHOD

Subjects

Twenty men and 12 women, all volunteers who wished to stop

smoking, served as Ss for this study. Most of these participants

were either "middle level" professional staff members or non-

professional personnel of the Edward Hines Jr. V. A. Hospital,

Hines, Illinois. Examples of the former were occupational

therapists, corrective therapists, and medical technologists;

and of the latter, secretaries and ward assistants. In addition,

a small number of Ss (five) were recruited through a small

classified advertisement placed in the local neighborhood

newspapers calling for volunteers for a V.A. hospital-sponsored

study, who wished to give up cigaret smoking. Hospital

personnel were obtained through the use of bulletin board

notices, personal contact, or referrals by other staff members

familiar with the investigation.

Prospective Ss were assessed for suitability in a pre-

liminary interview and then randomly assigned, as they became

available, to one of the treatment groups. These groups were

labeled the HI, H2, and H3 groups, corresponding to the three

major hypotheses, respectively. Group 4 was labeled and filled

in like manner when it became operational midway in the data

collection phase. Each group consisted of eight Ss; groups









HI, H3, and H4 received three female Ss each, while group H2

received two.

Those interested in participating were selected as

Ss if they were between the ages of 25 and 49, smoked an

average of at least one but not more than two and a half packs

of cigarets daily, and had been continuous smokers for at

least the past four years prior to their participation in the

study. In addition, all Ss had to voluntarily desire to stop

smoking and be willing to cooperate with all the study's re-

quirements. Those who indicated that they had been able to

stop smoking on their own for periods longer than two weeks

in the past were eliminated from further consideration.

Analysis of variance on data of age, number of cigarets

smoked per day, and total number of years smoked prior to par-

ticipation in the study revealed no significant differences

between the four groups at the .01 level of significance

(Tables 9,10, andll; Appendix A).

Apparatus

Electric Shock Source

A matched impedance shock generator was specially

constructed for use in this study. The circuit consisted of

a variable transformer with 115 v AC input and 0-120v output

which was connected to a 1,000 v CT step-up transformer. The

output of the latter was then connected through a 100 k, 100

w power resistor, a 0-10 milliammeter, and two 1/100 amp.

fuses to S. The intensity of the shock output to 5 was varied

by setting the dial on the variable transformer, and the









milliammeter allowed monitoring of the actual shock intensity

delivered. While the resistance of S, and therefore the im-

pedance of S, could be matched directly by varying the value

of the power resistor, this was not done, as it was not deemed

necessary.

This circuit made use of such safety features as an

isolation transformer which physically separated S from the

wall current, thereby preventing the occurrence of dangerously

intense shocks and burns, and a circuit fused on both sides of

S. This latter restricted the variability of shock and elim-

inated large surges of current from the circuit. In addition,

the chassis was grounded.

The S was connected to the shock circuit via Nu-way

snap leads, which were in turn fastened to snaps embedded in

rubber finger protectors. These latter were trimmed to pro-

vide a band approximately 3/4" wide, which slipped over the

finger like a ring. Both electrodes were placed on the fingers

of one hand, the index and third; thus, no current passed

across S's body. A light coating of Sanborn Redux electrode

jelly was first applied to the fingers.

Additional features of the unit consisted of a toggle

on-off circuit switch and indicator light, an electric counter,

and a remote switch for administering the shocks.

Timer

The device employed was an interval timer with auto-

matic reset made by Industrial Timer Corporation (Model P-4R).

Two plug receptacles, one for a remote switch and the second









for a standard AC load, were provided. Load-switch contacts

were rated at 15 amps., the time cycle was 0-15 seconds, and

the dial divisions were in quarters of a second.
*
Random Interval Programmer

The device used was a Gerbrands programmer, incor-

porating a Telechron synchronous motor (type B3, 110/120 v,

60CY) set at one RPM, and a standard microswitch. A loop

of 16 mm leader film, taking 30 minutes for one complete

revolution and randomly punched 40 times, was used to trip

the microswitch. The punch-hole diameter allowed the shock

circuit to remain open for one second with each successive

activation.

Experimental Room

All preliminary interviews and experimental condition-

ing sessions were conducted in an easily accessible private

office reserved for this purpose. The apparatus was arranged

so that S, sitting on the opposite side of a desk from E, was

unable to see the manipulation of the stimulus cards, remote

control switch, or shock generator dial settings. While the

shock generator sat on a low, small table at the right of E,

no attempt was made to conceal its presence. The random

interval programmer was mounted on a board attached to the

far edge of the table in such a way that neither S nor E

could determine beforehand when the next shock would occur.

In addition to the above-mentioned apparatus, such

items as chewing gum, life savers, peanuts, dietetic candies,

ash trays, and matches were provided in the experimental room.







Procedures

In order to maximize conditioning and enhance the re-

sistance to extinction equally across all groups, certain vari-

ables mentioned in the literature as being relevant to punishment

training were incorporated into all the treatment procedures.

Thus: initial shock intensities for every session were intro-

duced at levels perceived by the individual Ss as being dis-

tinctly unpleasant (Miller, 1960): novel stimulus items were

introduced from time to time in accordance with a pre-determined

schedule (McNamara and Wike, 1958) and, shock intensities were

varied randomly during each session from levels perceived as

just unpleasant to levels which bordered on being painful

(Church, 1963; Solomon, 1964).

Preliminary Interview

Prospective Ss for all groups were individually seen by

E in a preliminary interview. If all selection criteria were met,

a brief smoking history was then obtained, and the require-

ments for further participation were explained. These latter

included agreeing to: (1) come in for daily sessions over

the three-week experimental period for a total of 15 sessions,

(2) keep a daily count of cigarets consumed through comple-

tion of the experimental sessions; and (3) be available

for follow-up purposes over a three-month period. Ss were

then asked to continue their usual smoking practices until

their first experimental session, and also to begin keeping

daily cigaret consumption frequency scores. Small cards

the size of a cigaret package were provided by E for

this purpose. Ss were cautioned not to rely on memory for








the daily totals but to mark the cards each time a cigaret

was lit, regardless of the number of puffs taken. Ss were

asked to bring in these daily tallies along with two or three

packages of their favorite brand of cigarets for deposit,

when they returned for the first experimental session. This

latter request was made so that the act of purchasing cigarets

would not be tacitly encouraged once the sessions began. The

mean of the daily cigaret consumption frequency scores for the

period between the preliminary interview and the first experi-

mental session provided each S's cigaret consumption base

rate. This period varied from five days to a week and always

included three weekdays and a weekend.

Also at this time a brief explanation of smoking be-

havior in simple learning theory terms was offered by E. Smok-

ing was conceptualized as learned behavior which had become a

highly practiced habit in a variety of life situations. Ss

were told that the purpose of the experimental treatment

sessions was to provide an opportunity for "unlearning" this

behavior through the application of learning principles;

specifically, by associating an unpleasant stimulus -- shock

-- with that behavior which had come to acquire rewarding

properties. The experimental nature of the study was men-

tioned, and E offered himself as an "advanced graduate student

in clinical psychology" who was conducting research on methods

which would help people give up the cigaret smoking habit.

Before concluding the preliminary interview, several demon-

stration shocks were given in order to allay Ss' anxieties








about getting shocked, and to establish initial thresholds

for uncomfortableness and pain. An appointment for the first

experimental session was then arranged.

Approximately 35 individuals were disqualified from

further participation during this interview for one of several

reasons. A few smoked less than one pack of cigarets daily

or had not been smoking long enough. About 20 others were

unable to attend sessions on a daily basis. The remainder

either did not wish to subject themselves to electric shock,

or had second thoughts about giving up cigarets.

Stimulus Items

The stimulus items consisted of components of the smo-

king behavioral chain, ideational stimuli, and various

"precipitating stimuli" such as, e.g., the smell of cigaret

smoke, the sight of someone lighting up, and seeing a maga-

zine advertisement for cigarets. Table 1 lists the stimulus

items used, but not necessarily in the order presented. As

indicated, many of the items were presented during every

session, while others were introduced at pre-determined points

after the sessions began. Also, while all Ss received the same

number of items for each session, the content of several --

primarily the ideational items -- sometimes varied in accord-

ance with the idiosyncrasies of the individual S's smoking

behavior pattern. Thus, when asked to imagine, e.g., the

occasion for taking the first cigaret of the day, one S might

"see" himself reaching for his pack immediately upon awaken-

ing, while another might visualize taking his first cigaret

of the day after breakfast.

















0..0

U)
cm
Oc
a 0





































4->
0
a 0

r*









































0
0,e





0 -4
U
U
a o



0 .
01
O


N)


0
0
0'0














0
(9
i o

.
Co












H O
0














0 p
H



0 )


*HO G 1I
H 0 00
0 H 000w
> *H Oi i *H
C 00' C) O H.) -
*0 raH n0 0, 'H a 0



0 0u 3 0o -L-0
0CC~- O C)Od

) m 0 00 aH 0 *
0 0 ) H .00 c


0 OiH >0 4-''C0H0
a)) o 1ou oM


-1 0 a) C C v H
o u ni raO
C )0 4i rH 0 n
0 0 0 4 0 41H
W- (9 Q 0 0) 0 cc ;e0




U) 41 4- r rU (9
00 -' 0 H4-'

CID OOHO z 0
0) 0 40 m '.C 00'
0 *Ia oCr 0 0o 0


0)10 H T C ) (- ^ 'H 0i




r-H
4)
-'0o c
04 *H 0 0r
"** r -P P *-

0 a Hi 4- U -
0 0 *H *H H
n I'Se u U



0 U 9l r
0 ) rt O rH 0 0 H
).0H 04-' 0- a000


i u u aH0 'H

0

H








Sl Hc

.' C) 0
*H 'H 34-
HO




'0 0

0)4-'0 E '

0 c 4-'

0)I- 00


I 0

0 )- 0





u r-I :J
0V0 'A





S> 0> i e4 C)
U4 *PH *4-



r 0 0C

0 Co C
H 0000



0 a( 0

0 '0 (H >

H0 >u 0 H
'aC HO
SH O *H
O 0 00
Nmo a
*H (01
0 ) 'H 0 0 'H H
3 rd H>'
clD'O-'9*r1 3
> *H ) 3 '0



u)
0
I CD
HH (
.00( 0




S0 (9 *0

0 C C(H

0 00 0

N. 00
0 0 .

NH 3








'CM
00: 0
S0 Hn









O 0 0


0)|H a


al 0
HO 0
.OC
H1 '0






O 9 'H
00&0




0 N 'H


- 'H .4 00 H
HO O
Ha 0) 0z




000 0
00 46) w' H


S4-H1 r 0




;:j a) c



S 0 H
















Cd)
Ho 0 '
mi H
*H
4) O (90










0




001
0 nj























0







0C
















0)C




cc




) u
0)0


00
0)

0)0
11H






U,0
0









00
0

















W







Ln
U3)


4-'
H00
0)0














CC


'H
too














f)0
rIO







xm
'03



03

0rC



E4'
0r
"- C


** 0 4



* H| O *f )
0 C 00* 3


0)0 n 0) 0 0(
O o c0 0



- 0 0 'S *H
HO) U 0)0
00 0- .C00


4v 00Pri r >

1lc 0) 0 0 03
4 >


0 0 0 c3

U 0 >
H oU (o "I
*rl w1 4) ol





:CH 4' -'
C MC ,C ,ri ^






0 0 -H'



0 ) 0
0)





0) -H
.4H 0
1r

n HH

a0 a0


.0- 0,

o r







0

4 V
0) 0)0

a) 0)
3C 0
3 0



0 >-

S0 0 'H
U |4-) )
9400)


0a 0


C ) -H 0
0 0
0 3 *H 0


R n (
*H -' 0 )




H 0 V 0)1
00 4 > )
*Oi *H i
Od 0 0)



0H U) o -H )V
0 )O )0


0) 0 *0
40 00
H 0 0) 'H


0 0 0 R)


' 0) 3 0) 0 a0

)0 00
0 -H H 4Q


4 Q



r 03 4H)4-'

03 a00







.Q -H 4 H )
*H










a) H
Q) >1






S) *rl 0 C0 HM
0C u0 *H A


Oai c
O 3 41A r- .5










.' VR 0) -


0 4-' 0
V 04-' 0- 0


0 -) 0 H 0
ml a 0 *r .r
'H'O 4



a ri > e


H
0) k
V 0)



o 0
O OH-
0 H 0
X 0

Vx ('0 'H


03 .i r
4I-' U)
*H0

0
0 C'

0 0
aU R
p n4






4





S.rl







40


o -
-H0)

i H 0

a n









0
0. (0
O













0

> 0
0M4
) 4-1


4 1
0 *V

0) 0n) 0






'D


0)
I -H

*H 0 *
0o






0 H


U) 0
.0341

VO 0) 'rl
0) Hl


.0030
0U)







'H 0R
*rl I








C 013 0 V

MOO
4. -0
0*H *lIR
O 'H 'H 0) 0
,CR O




00 >'H >


D0 *r(H V]
*1


"0
0
OH
0 00

V (i) 'H
VI *rl
,3
H ,-

0 4-


H 0
0


0 0



) N
' O





H.C
0 0*






I r- 1
3n H 0)

0) -'
m)l> U

t














0~ v000
0)'. 0) 000
04- 4- ., .0 wH dU).H-

0 Q00-0 00 0
V) 'CH 0'0CRO 0

0) '(00+ w 0 0 (0 0) rj
4- '- 0 () .S' pfl- '0 *.- a)a,0U
00 V)00-lOU 0 0 'h 0 )0 (0
0 to H r r-'WI 41 ( 0000
(1.) HOft 0 W -,A-l u01-) H'.-) .
00q H 0 )-1 *H -lG) k 4-'
(E -1 01 *0 00i H 0'0'0 H 0
(1 4 0) 0( 0. -14 0) -d H
4-' U) XH f (-0 .-'4 (n"
0- 0 4-'0 4-1 r'-l -H.'
4-') 4-' m 0: 4-' 00 44- 00 u
00) d H U3 0 'cn;: 4-' cO 4-'-'
00 .0 4) .0 11 .00a0o0i
p4. W 00cC 4-'.00 4-' M 0
(40 w -'4-H H,- r.0' (n A
0 0O) HH m 0 0 0 4 )0 Hr- 4-
o 0 ( 4-'C0 004-' -)H 0 00
n H r4 NO 4 > N 00)

0 rC-1'- C)~ a).0 '04 C5:s0 4-'
0. l .0 (n 9 :0 .0 (1) a (1)00 C)-r
q q Ix F H + fA M 4





(90 0 w 00 0 r (A 0.040)4-' (a)'- 0)
H1-i ( >I -14 0 U) >0)A~-14)r rH-'I 41>,(
04 )O0- I 0H rd0 r -
U) I c F +j 0 r







'0)
En e p r 41
4 a) u 0
04 .0 0 N ri (d 0C
;3 (a) U ) ,I qr o~ e n
0 o Xl *E







0 11 A 0' 1,- v
H (

0 0)
0.) (n 0J 0 0 C5'






0 s )0 () 0 Tq0, 0D
() HV)- 4) 0 0 1
H r n4 0f 0) 0 )H4
z rd ;4 t4-)
0l 00 (00


coIr' a o


.0 00
H~ H
a) 0C) 0 z-Ha0. 14 0
>3E~, C F2 41 41

0 CC tt~( r-q00) C040 l
k -ri (n x -r-
H 0. 0 0U 004H







0 1) 0) 0 0'4-4Z 0 0 0)0 C
H ~ .( 4- 'H 0 0 4 0
001 (01- 0)( O.0I( d01'H En 0d
0) 4(00 ri Y-H r, 0 U
) d* f a ) (
4I 0) 01 0 H Q 0 Q


4- .0 0 Hm 0 1"q .r-q






U) 41 a0 0 4 0'0 4-'(0)
-14 00 0 >-'4-' "t 0 X ;4 0 "1
(n (a) 4 -10 COO *H ) 1 O v40 H (






c ) a ) U) v -i f r ri i +
u' -H (n 0 .
I H H (04-' 'u)(O 4-' i

a~l 00H( 0T a0 000)4)t -
00. clou ~o c 4-'00 0 ~ 4-'0 c.-). 00(04-' +'
4-' *H .0- -I 'H 00 000 'HH r
(-40 '0'0U) (00 '0 W10H004-" 0) 0 ~l a

0o U) 0...C U U).0'0 CC ).0 044 H4-'( ~- d r l~
rcl I~ 00~ c rr 03 0r 'HO 0','.( (4 'H4'H 00I

(I) 0llJ' 0'lu 0 *1-)l lr 6~Ovuo i
" I r H









Item presentation was random. Each was written on an

index card, and the cards were shuffled before each session.

On occasion, changes were made by E as the individual cards

came up to provide for a more logical ordering of the items.

Experimental Shock Sessions

The format followed during the sessions was essen-

tially the same for all groups. Upon entering the experimental

room, Ss pulled the two electrode-embedded rubber bands on the

index and third fingers of their smoking hand so that the metal

snaps were positioned against the palm side of the fingers.

The bands were placed far enough back on the fingers so that

normal finger dexterity was not unduly hampered. The pre-

vious day's cigaret consumption tally was then recorded by E.

Stimulus item presentation began after a quick check by E

determined that the electrodes were positioned correctly and

the apparatus'was connected properly. For all groups, the

sessions terminated when the electric counter on the shock

generator indicated that the S had received 40 shocks. The

sessions lasted, on the average, about 30 minutes, and, with

the exception of the H4 group Ss, all Ss received a total of

600 shocks over the 15 sessions. The H4 group Ss averaged

350 shocks over this period.

At the start of the first session, each S was advised

that no specific restrictions would be placed on his smoking

behavior during the duration of the study. It was suggested

at that time, however, that if he attempted to "do something

else instead" in response to the urge to smoke, progress








towards the goal of terminating smoking would possibly be aided.

Several alternative responses were then suggested as possibil-

ities. Examples of these were the following: taking a deep

breath and holding it for 20 or 30 seconds, chewing or eating

some gum or candy, taking a few sips of cold water, performing

an isometric exercise, or reviewing one's own reasons for want-

ing to stop smoking. It was then suggested that each S experi-

ment with such alternatives until he found those which best

suited him.

This approach was decided upon for several reasons. It

soon became apparent in working with several pilot Ss, and in

general conversations with smokers, that many, if not most

smokers had at one time read or heard about various ploys one

could utilize to stop smoking. Many had tried one or more of

these methods themselves. And too, some Ss wondered whether

they should "fight" the effects of the experimental procedures,

or do anything to help on their own. Telling Ss they could try

to reduce their cigaret consumption away from the sessions, as

well as suggesting some things that they could do, helped to

standardize S attitudes and motivation, and also introduced a

measure of experimental control.

HI Group -- Ss in this group received electric shocks

of one second duration, administered at the points indicated in

column 2 of Table 1. Shock onset was controlled by means of a

remote control hand switch held below desk level; the shock

stimulus was terminated by the circuit's automatic reset timer.

No special instructions were additionally given to the HI

group Ss.








H2 Group -- While the Ss in this group received shocks

of variable duration, the shock onset points were identical

to those for Ss in the H1 group above. Before each H2 group S

entered the experimental room, the automatic reset timer was

disengaged from the circuit, thus enabling E to control both

shock onset as well as shock termination. H2 group Ss were also

given the following special instructions at the beginning of the

first experimental session in addition to the general instruc-

tions noted previously:

Once the shock begins, it will not turn off until you
proceed to do something or say something, either as an
alternative to what you will be doing upon my request,
or in response to a question I might ask you. Your
task, then, will be to respond in such a way that the
shock will be turned off. Remember, you yourself will
be able to turn off the shock every time by responding
correctly in each situation. Let's take an example.

The S was then asked to "light up", and shock onset occurred as

he put the cigaret in his mouth, but before he lit it. "Correct"

responses here included removing the cigaret and laying it down

on the table, breaking the cigaret, putting it back in the pack,

or throwing it in the waste basket. If the S did not immediately

dispose of the cigaret, or if he removed it from his mouth but

continued to hold it in his hand, E then said, "Remember now,

you can terminate this shock. What can you do with that cig-

aret in order to turn the shock off?" In all instances, this

was sufficient to prompt the S to get rid of the cigaret.

Item presentation then proceeded in regular fashion.

There were several "correct" responses, then, which the

S could offer for most of the items. The third column of








Table 2 lists examples of escape responses which were defined

as acceptable. To deter stereotypic or repetitious responding

to any given item as it came up through the 15-session sequence,

and to encourage the development of an array of incompatible-to-

smoking response tendencies, the same escape response was not

always allowed to be the correct one. Often, when a S would

respond in a manner which had previously proved to be "correct,"

the shock would, nevertheless, continue, and E would say, e.g.,

"Yes, but what else could you do in this case?"

H3 Group -- The Ss of this group received electric

shocks of one second duration, administered at random intervals.

The shock generator was plugged into the random programmer

before the S entered the experimental room, and immediately

after the electrodes were positioned, the circuit was activated.

Thus, E neither controlled shock onset nor shock termination.

No special instructions were additionally given to the Ss in

this group. It was often necessary, however, for E to terminate

the S's performance at the point at which Ss in the other three

groups were getting shocked, in order to maintain stimulus item

equivalency for this group. For example, if the stimulus item

card called for shock onset to occur as the S placed the cigaret

in his mouth, the 1H3 group S was told at this point to dispose

of the cigaret and place the cigaret package back on the table.

H4 Group -- The procedures for Ss in this group were

identical to those already described for the 112 group Ss, with

the following exception: At the end of the first experimental

shock session, each S was told that any given subsequent session








could be avoided if, on the immediately preceding day, he com-

pletely refrained from smoking any cigarets. (The two week-

end days were counted as one day.) Each S did, however, have

to "report in" by phone or in person each weekday morning in

order to apprise E of his smoking performance during the pre-

ceding day. It was pointed out to each S that, in effect, he

could determine the number of sessions he would have to attend

during the three-week experimental period.

Follow-Up

Cigaret consumption follow-up data were collected for

all Ss two, six,and 12 weeks after treatment termination.

Ss were contacted two days prior to these dates and asked to keep

tallies over a three-day period. Three-day means were then

computed for the follow-up cigaret consumption scores. At

the end of the 12-week follow-up period, each S was asked to

informally express any impressions or thoughts he had about

the study or his participation in it. These will be explored

in the Discussion chapter.













CHAPTER III

RESULTS

The dependent measure of this study consisted of the

per cent reduction scores computed for each S during both the

experimental treatment and follow-up periods. These scores

were based upon the mean of each S's pre-treatment cigaret

consumption tallies, obtained between the preliminary interview

and the first experimental session-day. Each individual's pre-

treatment mean was given a value of zero, and any subsequent

reduction in smoking was converted from this base line measure

into a per cent reduction score (or, in another sense, a per

cent improvement score). For example, if a S's pre-treatment

mean consumption rate had been 40 cigarets per day, and he

then smoked 30 cigarets during the second session-day, his

per cent reduction score for that day would have been 25 per

cent (30 divided by 40 = .75; .75 subtracted from 1.00 multi-

plied by 100 = 25 per cent). A per cent reduction score of

100 then, would indicate that the S did not smoke any cigarets

on that particular day. Individual per cent reduction scores

were computed from the number of cigarets each S smoked on

each of the 15 session-days, and from the mean number of

cigarets smoked during the three-day intervals two, six, and

12 weeks after treatment termination. These individual per

cent reduction scores are shown in Appendix B. A total of 11

45








Ss, eight during the first week and three during the second,

were dropped from participation after treatment began. Five of

these decided they no longer wanted to stop smoking, and

the other six either couldn't make the treatment sessions on

a daily basis or failed to show up for their scheduled appoint-

ments. The partial records of these 11 Ss were not included

in the data analysis nor are they shown in Appendix B.

Figure 1 shows the MPSR scores of the four groups plotted

across both the experimental treatment and follow-up periods.

As hypothesized, the H4 group MPSR scores are consistently lar-

ger than those for the other three groups across the session-

days, but the relative rankings of the other three group curves

are less pronounced. The 15th session-day MPSR scores of 97,

91, 89, and 86 for the H4, H2, HI, and H3 groups, respectively,

are ranked in accordance with the group ordering predicted by the

hypotheses. Two, six, and 12 weeks after treatment termination,

however, the relative group rankings can again be seen to be

ordered somewhat differently, with the largest MPSR scores

consistently being attained by the H2 group.

Perhaps the most notable feature of Figure 1, however,

is not the relative orderings of the group MPSR scores at

specific points on the horizontal axis, but rather the high

degree of concordance of the curve slopes across both the

session-days and the follow-up periods. This concordance suggests

that the differential effects of the experimental procedures

on the mean smoking reduction rates of the groups were not




































C11 f *
UU


















0 H
m c i




o I *




I.1
H u H I




H *f
0I I I H

S . I 8 H
Q I Z 6


-i /7I U) H O t 0






I/ H H
I V
I v / C







I .I*



.-

H I) 0) f S3 0- 0











1-1


DNIXONS NI NOIlonafN NC O iHd









great throughout either the experimental treatment or follow-

up phase of the study. Analysis of the data does, in fact,

bear this out.

Table 2 shows the results of a repeated measurements

analysis of variance of the H1, H2,and H3 group MPSR scores

compiled during the experimental treatment period. The H4

group was excluded from this primary analysis, as the Ss in

this group differed from those in the other three in the number

of shock sessions they received. (The mean number of shock

sessions administered the H4 Ss was 8.5; the least number of

sessions a H4 group S received was five, and the most, 12.)



TABLE 2

REPEATED MEASUREMENTS ANALYSIS OF VARIANCE OF THE MPSR SCORES
ACROSS SESSION-DAYS--GROUPS HI, H2, AND H3
N = 24


Sources of Variation df Mean Squares F P


Between Ss

Group Procedures 2 901.50 < 1.00

Ss Within Groups 21 5031.05

Within Ss

Session-Days 14 7901.36 50.40 <.005

Procedures by 28 82.25 < 1.00 -
Session-Days

Session-Days by Ss 294 156.76
Within Groups








From the results of this analysis of variance, it is

evident that neither the differential effects of the various

group procedures, nor the procedures by session-days interac-

tion were significant sources of variance. The main session-

days effect--i.e., the effect of treatment repetition over time--

was, however, highly significant (F = 50.40; P<.005). Part

(2)a of Hypothesis 2, then, was not supported.

The HI, H2, and H3 group MPSR scores across session-

days were then combined, and a Neuman-Keuls test of all the

ordered pairs of session-day means was computed. The results,

shown in Table 3, corroborate what the group curves suggest in

Figure 1; namely, that most of the smoking reduction occurred

during the first half of the experimental treatment period.

As Table 3 indicates, no further increase in per cent smoking

reduction, from the eighth session-day to any of the remaining

seven session-days, attained statistical significanceat the .05

level of confidence.

In order to determine what effect the inclusion of the H4

group MPSR scores would have on the Group Procedures F ratio, a

second ancillary repeated measurements analysis of variance was

computed. Despite the slight divergence of the H4 group curve

seen in Figure 1, the results of this second analysis, shown in

Table 4, parallel those obtained in the first analysis. It is

interesting to note that the Group Procedures mean square

is, relatively speaking, much larger than the corresponding one












mOO co mO L oco



***H**********






- C C H-I H H
0 c N (31 Ol) I- ) N


C') CVO bc I I l









c 1 I I I

S c f c- --O ie-- ,- 4 -1


N C C H- H H

S M o t t I I I I








m o ) CV8 ) c 0 0
N N (--\ I I I I I


z O I I I IM I I I I I I I












CiC2H
m I I I I I I I I I I I I I











* * "



* **
( 1 1 1 i


















01r-- r
(M totlalo Or-lW






*
HNrr



t**


siftd a laaw
uaahm-aa saouajaJJ!a


NC
r-I












(ln

> 0
0
*I,-

U)

0)






O
41 0









obtained in the first analysis. Nevertheless, only the Session-

Days main effect was, again, a statistically significant source

of variance (F = 56.85; P<.005). These results, then, failed

to confirm both Part (2)a of Hypothesis 2 as well as Part (a)

of Hypothesis 4.



TABLE 4

REPEATED MEASUREMENTS ANALYSIS OF VARIANCE OF THE MPSR SCORES
ACROSS SESSION-DAYS--GROUPS H1, H2, H3, AND H4
N = 32


Source of Variation df Mean Squares F P


Between Ss

Group Procedures 3 5723.33 1.38

Ss Within Groups 28 4159.00

Within Ss

Session-Days 14 10312.71 56.85 <.005

Procedures by 42 145.28 <. 1.00
Session-Days

Session-Days by Ss 392 181.39
Within Groups



Finally, with respect to the data obtained during the

experimental treatment phase of the study, two analyses of

variance of the 15th session-day MPSR scores were computed.

While all Hi, H2, and H3 Ss received an experimental shock

treatment on this last session-day, six of the eight H4 group

Ss avoided a shock session on the last day because they had

abstained from smoking on the preceding day. To control,








then, for the effects of shock, per se, on cigaret consumption

on this last experimental treatment day, only the MPSR scores

of the first three groups were included in the first, or pri-

mary, analysis of variance. The results, summarized in Table

5, reveal no significant differences between the MPSR scores

of the three groups; therefore, they failed to support Part

(2)b of Hypothesis 2.



TABLE 5

ANALYSIS OF VARIANCE OF THE MPSR SCORES ON THE 15th
SESSION-DAY--GROUPS HI, H2, AND H3
N = 24



Source of Variation df Mean Squares F P


Procedures Between 2 47.79 < 1.00 -
Groups

Procedures Within 21 256.58
Groups



A second analysis of variance, this time including the

H4 group MPSR scores on the 15th session-day, was additionally

calculated. The results, shown in Table 6, also indicate no

significant differences between the group MPSR scores, al-

though again, this second Group Procedures mean square is

larger than that obtained in the first analysis. The results

again did not support part (2)b of Hypothesis 2, as well as

Part (b) of Hypothesis 4.




53


TABLE 6

ANALYSIS OF VARIANCE OF THE MPSR SCORES ON THE 15th
SESSION-DAY--GROUPS HI, H2, H3, and H4
N = 32




Source of Variation df Mean Squares F P



Procedures Between 3 169.37 < 1.00
Groups

Procedures Within 28 205.97
Groups



With respect to the data compiled during the follow-up

period, a final repeated measurements analysis of variance of

the MPSR scores of all four groups computed two, six, and 12

weeks after treatment termination was then calculated. As the

independent variable -- the passage of time -- operated equally

for all groups, the H4 group MPSR scores were included, and

only one analysis was made. The results are summarized in

Table 7. Again, the differential effects of the experimental

procedures, this time on the recovery rates of the groups,

were not statistically significant at the .05 level of con-

fidence, nor, was there a statistically significant Procedures

by Follow-Up interaction effect. The main effect of time

(Follow-Up) was, however, significant beyond the .005 level of

confidence. These results, then, failed to support Part (2)c

of Hypothesis 2 as well as Part (b) of Hypothesis 4.








TABLE 7

REPEATED MEASUREMENTS ANALYSIS OF VARIANCE OF THE
MPSR SCORES TWO, SIX, AND 12 WEEKS AFTER
TREATMENT TERMINATION--GROUPS HI, H2, H3, and H4
N= 32



Source of Variation df Mean Squares F P


Between Ss

Group Procedures 3 454.33 < 1.00

Ss Within Groups 28 2312.32

Within Ss

Follow-Up 2 12356.00 37.43 <.005

Procedures by 6 68.00 < 1.00
Follow-Up

Follow-Up by Ss 56 330.09
Within Groups



Combining the MPSR scores of all the groups, a Neuman-

Keuls test of the differences between all ordered pairs of the

two, six, and 12-week means was then computed (Table 8). The

results indicate that the differences between both the two and

six-week, and six and 12-week mean MPSR scores were signifi-

cant at the .01 level of confidence. It is interesting to note

that the first mean difference is approximately twice as large

as the second, despite the fact that the six-to-12-week in-

terval was 50 per cent longer than the two-to-six-week inter-

val. Thus, it would appear that the smoking recovery rate,

as suggested by the group curves during follow-up (Figure 1),

is a negatively accelerating function of the passage of time.









TABLE 8

NEUMAN-KEULS TEST OF ALL ORDERED PAIRS OF FOLLOW-UP
MEANS FOR GROUPS HI, H2, H3, AND H4


Ordered Means
40.0 52.8 78.6


Ordered Follow-Up Points
1 (12 wks.) 2 (6 wks.) 3 (2 wks.)


Differences 1 12.9* 38.6*
Between
Mean Pairs 2 25.7*

*P < .01


To determine whether the mean cigaret consumption scores

of the four groups were significantly lower than their respec-

tive pre-treatment levels on the 15th session-day, and two, six,

and 12 weeks after treatment termination, a single t-test (one-

tailed) of the difference between the over-all pre-treatment

and 12-week correlated means was computed (r = .24). The

three-day interval means of each S, compiled from the actual

numbers of cigarets smoked by all 32 Ss on these two occasions,

were the data used in the calculations. (See Appendix C).

The "t" value obtained (5.29) was significant beyond the

.0005 level of confidence. (Pre-treatment M = 34.3, S.D. =

6.96; 12-week M = 20.3, S.D. = 13.24.)

The justification for using the over-all pre-treatment

and 12-week means to compute only one "t" followed from the fact

that the pre-treatment cigaret consumption scores, and the

15th session-day, and follow-up MPSR scores of the four groups









did not differ significantly from each other (see Table 10,

Appendix A; Tables 6 and 7). Thus, if the "t" value for the

difference between the over-all pre-treatment and 12-week means

was significantly large, then the differences between the over-

all pre-treatment mean and the over-all 15th session-day, two-

week,, and six-week cigaret consumption rate means would also

have to be statistically significant; these latter over-all

mean differences would have been even larger than the differ-

ence between the over-all pre-treatment and 12-week means.

And, since the cigaret consumption rates of the four groups

themselves did not differ significantly from each other at any

point, then it could be said that the cigaret consumption rate

of each group on the last day of treatment, and during follow-up,

was significantly lower than its pre-treatment level. Thus,

Hypothesis 1, Part (1) of Hypothesis 2, and Part (1) of Hy-

pothesis 4 were supported. Hypothesis 3 was not.

In summary, then, the prediction that the cigaret con-

sumption rates of the four groups would differ significantly

from each other in a prescribed fashion, as a function of the

differential effects of the experimental procedures each group

received, was not supported in any way. This was true for

both the experimental treatment and follow-up phases of the

study. Irrespective of the nature of the aversive shock treat-

ment received, the mean performance of each group was essen-

tially the same as that of the other three. The prediction

that the cigaret consumption rates of the HI, H2, and H4

groups on the last day of treatment, and during follow-up








would be significantly lower than their respective pre-treat-

ment levels was supported; the prediction that the H3 group's

cigaret consumption rates would not be significantly lower

was not.

Additionally, it was observed that the Session-Days

main effect (the effect of treatment repetition over time) was

the only significant source of variance contributing to the

reduced cigaret consumption rates of the groups during the

experimental treatment phase. Upon combining the MPSR scores

of the HI, H2, and H3 groups, it was found that after the

eighth session-day, no further decrease in smoking during the

remaining seven session-days attained statistical significance.

Finally, during the follow-up phase, smoking recovery, as

evidenced by the increased smoking consumption rates of all

four groups, appeared to be a negatively accelerating function

of the passage of time. There were no other significant

sources of variance.













CHAPTER IV

DISCUSSION

The two major outcomes of this research were the

following: (1) the failure of the results to demonstrate a

significant Group Procedures main effect, both during the

experimental treatment and follow-up phases; and (2) the finding

that cigaret consumption rates of the groups, all varying

together, were significantly lower than their pre-treatment

levels during both the experimental treatment and follow-up

phases. Thus, the inherent differences imputed to the treat-

ment procedures as a function of the conditioning models upon

which they were based, were greatly attenuated in practice.

Even so, the above findings demonstrate that treatment var-

iables common to all four experimental treatment situations

were operating to effect a significant smoking reduction for

all four groups. This common over-all treatment effect was,

in all probability, either the result of (1) confounding

arising from the procedures themselves which served to make

the procedural effects more similar than dissimilar, (2) the

presence of uncontrolled situational variables, common to all

the treatment conditions, which overshadowed or negated the

differential effects of the individual treatment procedures,

or (3) some combination of both (1) and (2).








Confounding as a Function of the Procedures

Reactive Inhibition

During each experimental treatment session of approxi-

mately 30 minutes' duration, 40 stimulus item presentations

were made. The HI and H3 group Ss simply responded to each

and were, at least in the case of the former Ss, then shocked

for one second at the appropriate shock point. The situation

was, however, more complicated for the H2 and H4 group Ss. Upon

the presentation of each stimulus item, these Ss had to first

begin the task of arriving at the "correct" escape response

which would terminate the distinctly unpleasant shock. It

was not uncommon for 20 or more seconds to elapse between

shock onset and shock termination. The "activity level"

during the H2 and H4 group treatment sessions, then, was far

greater than that which obtained during typical HI and H3

group sessions.

One consequence of this was a shortening of the inter-

stimulus item intervals for the H2 and H4 groups, a situation

somewhat analagous to "massed practice." Increased response

effort, a result of this "massed practice" effect, as well as

heightened tension as a consequence of far greater exposure to

shock, led to the H2 and H4 group treatment sessions being far

more intense and task-oriented. This state of affairs may

well have resulted in a buildup of response inhibition during

each session, a phenomenon experimentally known to adversely

affect resistance to extinction (of, in this case, the newly

acquired alternative responses to smoking) (Kimble, 1961).







Thus, while in theory, the H2 and H4 group treatment procedures

should have resulted in the systematic positive reinforcement of

appropriate non-smoking escape responses, and, therefore, longer

lasting smoking behavior suppression, the contaminating effects

of reactive inhibition may have attenuated this expected result.

Intermittent Reinforcement

Probably the most surprising group performance was that of

the random shock (H3) group, a group for which it was predicted

there would be no significant mean reduction in smoking, both

during the experimental treatment and follow-up phases. Once

again, it would appear that the number of stimulus item presenta-

tions during the 30-minute session, as well as the frequency of

shock onset--for the H3 group, an average of one shock approxi-

mately every 45 seconds--were important factors in determining

the results obtained by this group. With the occurrence of 40

stimulus item presentations, it was inevitable that many of the

shocks were delivered at points in the temporal order which were

appropriate for conditioning; i.e., shock onset was often con-

tiguous with some aspect of a S's ongoing performance of a motoric

or ideational smoking response. At other times, the shock would

be delivered after the "optimal" point in the temporal order had

passed. Thus, in effect, the H3 group was in many ways as

much a partial reinforcement group as it was a random shock group.

As there is experimental evidence indicating that inter-

mittent negative reinforcement of an operant acquired under

essentially positive reinforcement contingencies not only leads

to behavior suppression, but also increased resistance to

recovery of the suppressed response (Mowrer, 1960), this may

explain in part the performance of this group, particularly








during follow-up. The issue is less clear with respect to the

possible effects of delay of (negative) reinforcement, but

there is some evidence to indicate that this phenomenon,

especially if the delay is \ir3able, increases resistance to

recovery over that obtained by immediate punishment alone

(Crum, et al., mentioned by Feldman and MacCulloch, 1965).

While it is not possible to determine to what extent the

effects of intermittent reinforcement, as well as delay of

reinforcement, adventitiously increased the mean smoking re-

duction rate of the H3 group, the possibility does exist that

it may have been considerable.

Respondent Conditioning

It might also be argued, again with the mean smoking

performance of the H3 group primarily in mind, that the internal

response states of the Ss came to acquire suppressive properties

during the experimental treatment sessions as a function of

their contiguity with electric shock onset. These internal

respondents, then, elicited in subsequent situations con-

ducive to smoking--or to put it in slightly different terms,

in the presence of those CSs which typically would have

precipitated smoking behavior--may have served to attenuate

a given S's desire to smoke. If such respondent conditioning

did in fact occur to a significant degree, this might help ex-

plain why the mean smoking reduction rate of the H3 group

in particular, but also for the HI group, was not sig-

nificantly different from the mean smoking rates of the other

two groups, especially during the follow-up phase.








It is possible, then, that the variables mentioned in

this section, either singularly or in combination, may have

caused the net effects of the treatment procedures on the Ss

to be more alike than dissimilar. Such confounding, as a

function of the treatment procedures themselves, might explain,

at least in part, the absence of significant results obtained

in this research. In the next section, several possible con-

taminating factors, arising from over-all experimental conditions

common to all the groups, will be looked at.

Situational Variables as a Source of Confounding

Interpersonal Effects

Many behavior therapists have increasingly focused

their attention on the issue of the importance of the therapist-

patient relationship as a catalyst for behavior change. For

example, Barker (1965) talks about the "personal attraction"

which may develop towards the therapist, and which "can't be

ignored'." Andrews (1966) maintains that behavior therapists,

in common with traditionally oriented therapists, are sup-

portive, authoritarian, directive, encouraging, etc., in

response to the needs of their individual patients, and that

the establishment of satisfactory relationships is mandatory

if behavior change is to occur. Feldman and MacCulloch (1965)

admitted that their patients "liked to talk" and that they often

gave them advice and reassurance. These authors claim that

such practices are necessary in order to gain good "background

rapport." Coates (1964), and Meyer and Gelder (1963) assert

that in all of the conditioning procedures employed to date in








the clinical literature, the therapist-patient relationship

has played a major, if not always recognized, part. And Oswald

(1962) has claimed that the success of aversive conditioning,

in particular, is vitally dependent upon therapist-patient

relationships.

It is perhaps impossible to determine what part re-

lationship variables played in influencing and determining the

results of the present study. Koenig and Masters (1965) used

seven therapists to treat 42 smokers and found a significant

therapist difference (p <.05), but not significant treatment

or interactional differences. Thus, the therapist to whom the

smoker was randomly assigned, and not the treatment method,

was the significant determinant of success with respect to

smoking reduction. However, Ober (1967), using three therapists,

found no significant treatment, interaction, or therapist

effects in his study of smoking behavior. He attributed this

lack of a significant therapist main effect to the "highly

standardized" treatment procedures his therapists adhered to.

Nevertheless, as the smoking reduction scores for the three

treatment groups in his study were significantly lower than

their pre-treatment levels upon treatment termination, the

possibility still remains that relationship effects common

to all groups were responsible for this over-all reduction to

some significant degree.

With respect to the present study, the attempt was made

to minimize E's influence on the mean smoking consumption rates

of the experimental treatment groups. For example, not only








were the treatment presentations standardized, incidental or

unnecessary conversation was discouraged, and comments of an

evaluative nature concerning the smoking performance of the

Ss were withheld. Nevertheless, it may be naive to assume that

such attempts alone can effectively control or significantly

minimize the E influence on S performance. It was noticed,

e.g., that many of the Ss still appeared to view the treatment

session as an occasion for non-task verbal interaction. Such

Ss frequently attempted to bring up conversational material

of a more personal nature. Others either appeared to want

some sort of confirmation that they were progressing satis-

factorily, or encouragement from E that they would, in fact,

be able to give up cigarets. On occasion, Ss would appear

angry, implying by their comments that E was being "unfair"

for continuing to shock them despite the fact that they were

obviously doing well in their efforts to quit smoking. Ex-

amples of "resistance"--the breaking of appointments, arriving

late, etc.--were sometimes manifest.

Rosenthal (1966), in his recent book on experimenter

effects, discusses an array of situational variables which

have been shown to influence research outcome. Of particular

relevance for the present study is the one he labels the

"acquaintanceship" variable. Since many of the individuals

who served as Ss either worked on the same or adjacent wards,

or ate in the same lunchroom as E, the treatment sessions were

not the only source of E-S contact. For these individuals,

then, E was more than an anonymous person who "shocked them








for smoking." He was also an acquaintance and co-worker. Under

these circumstances, it is possible that at least some Ss re-

duced or terminated their cigaret consumption--especially

during the treatment phase--either because they didn't want to

"disappoint" someone they knew on an individual basis, or

because they felt guilty or embarrassed about failing in such

a person's presence.

It is also interesting to speculate about the degree

to which E's aversive properties were enhanced during the

treatment phase of this research. Through repeated association

with electric shock, and by virtue of being the person who,

insofar as the perception of many of the Ss was concerned,

was "trying to get people to stop smoking," E may have acquired

significant aversive stimulus properties in his own right. In

this vein, Rosenthal also points out the tendency for Ss to

perceive, either correctly or erroneously, E as someone who

"expects" them to respond in accordance with their perception

of the goals of the experiment. And, as Rosenthal continues,

Ss often do just that, primarily for this reason alone. Thus,

E's very presence in the hospital setting may have affected the

smoking consumption rates of many Ss beyond that which would

have obtained from E-S contact confined only to the treatment

room.

Three months after treatment termination, each S was

informally asked to give any impressions he had about the

treatment he had received. Perhaps indicative of the importance

of the relationship effect was the observation offered by al-








most every S that E's presence in the treatment situation was

an extremely important source of smoking behavior influence.

Many Ss reported, in fact, that this influence continued after

treatment termination. On the other hand, approximately 80

per cent of the Ss either denied or downgraded the importance

of shock, per se, as being a major factor in their reduction

or cessation of smoking. Perhaps an example from Goldiamond's

(1965) review of stuttering and fluency research is most

apropos at this point. Goldiamond mentions one S who completely

denied that the occurrence or non-occurrence of shock during the

experimental period had anything to do with his non-fluency

rates, even though the data clearly indicated that the S's verbal

behavior had been under direct control of the reinforcement

contingencies. Nevertheless, while it is perfectly plausable

to suspect that the Ss in the present study were either unaware

of, or felt the need to deny, the effect shock had on their

smoking behavior, it is an interesting fact that the major focus

of their comments was on the interpersonal aspects of the

experimental situation.

Subject Motivation

In all likelihood, S motivation represents a variable

complex whose effects on performance and treatment outcome are

only incompletely understood and poorly controlled (Meyer and

Crisp, 1966). A number of writers have discussed the importance

of positive initial attitudes towards therapy and strong

motivation to change, with respect to the ultimate outcome

(e.g., Lazarus, 1963; Meyer and Gelder, 1963). The Ss used








in this study all appeared, at least initially, to be well

motivated. All were voluntary participants, professed the

strong desire to give up smoking, and had one or more per-

sonally significant reasons underlying their desire to give

up cigarets. Yet, motivation was often observed to fluctuate

during the course of the study in ways which may have intro-

duced important changes into the experimental situation.

The most common S reaction observed by E after the

sessions had gotten under way, was the emergence of ambivalence--

"second thoughts" about giving up cigarets "at this time."

Some Ss seemed dismayed that the task of giving up cigarets

might require effort and hard work on their part; i.e., that

there was no "magic" involved. Others seemed to realize, the

closer they came to the goal, the extent to which they had be-

come dependent upon cigarets. At least five or six Ss expressed

great concern about failing; i.e., not being able to quit

after committing themselves to spouses, relatives, or friends.

Perhaps the most interesting reaction noted was the

tendency for many of the Ss across groups to become "unhappy"

with the course of treatment, especially around the 7th, 8th,

or 9th session. This was particularly pronounced if, by that

time, a given S's cigaret consumption rate had declined

sharply. Such Ss often attempted to negotiate new terms with

B, the goal being to attenuate the original agreement to meet

for the full sequence of 15 sessions on a daily basis.

It was primarily for this reason that the H4 group was

begun. It was felt that if Ss could control, in part, the

amount of punishment they received, their motivation to terminate








smoking more quickly would be strengthened. The reward value

of avoiding a shock session on the day immediately following

one free from smoking, it was further felt, would provide the

Ss with sufficient incentive to continue abstaining from

smoking on the day that the session was being avoided. It

was hypothesized, then, that after such Ss had been able to

avoid getting shocked for several days as a consequence of

successfully abstaining from smoking, their ability to continue

not smoking after treatment termination would be correspond-

ingly greater than that evidenced by the HI, H2, and H3

group Ss. As the H4 group mean cigaret consumption rate

during this period was not significantly different from

those of the other three groups, it is obvious that the above

contention was not supported.

Perhaps the punishment value of the shock sessions

themselves may have been over-estimated. If so, then it

might be logical to assume the following: that the amount

of positive reinforcement obtained through shock session

avoidance was not sufficient to establish inhibitory or self-

controlling mechanisms powerful enough to overcome the urge

to smoke, once the threat of punishment (attending shock

sessions) was removed. On the other hand, it is also possible

that the differential effects imputed to the H4 group pro-

cedure--and to the other group procedures as well--may have

been viable and operating as hypothesized. However, these

experimental effects, though present, may have been over-

shadowed by more potent situational variables common to all

the groups.








In short, much of the smoking reduction or cessation

evidenced by all groups during the experimental treatment

phase of this study may have been induced by interpersonal or

relationship considerations mentioned in this section. It

should be pointed out that even the H4 group Ss, who attended

an average of only 8.6 shock sessions over the three-week

experimental period, received daily E contact whether they suc-

cessfully avoided a session or not. And, insofar as

follow-up performance is concerned, motivational factors

(i.e., ambivalence about really giving up cigarets, possible

feelings of dependency and loss, etc.) may have accounted,

at least in part, for the degree of smoking recovery evidenced

by all the groups. In the next section, some considerations

for future research bearing on the points mentioned in this

chapter will be discussed.

Some Issues for Future Research

If the major questions posed by the findings of this

study are to be resolved in a satisfactory manner, several

issues will have to be considered and dealt with in subsequent

investigations. Before proceeding, one point should be made

clear. Even though the smoking reduction rates obtained in

this study compare quite favorably with the results of other

smoking investigations reviewed earlier in the Introduction

chapter, the major concern of this research is not smoking

reduction or cessation, per se. The major issues are (1)

whether treatment procedures based upon an active escape








conditioning model are any more effective in suppressing un-

wanted or maladaptive behavior than those based upon simple

punishment models, and (2) what the effects of random negative

reinforcement are on the performance rates of such behaviors.

As this chapter's discussion clearly suggests, before

the differential effects of various treatment procedures can be

successfully compared, they must first be demonstrated in

practice. Therefore, to the degree that it is possible,

potential sources of confounding pointed out in the pre-

ceding pages must be controlled or removed from future ex-

perimental situations. Perhaps the first possible source of

confounding that should be dealt with is the relationship

variable complex.

It is apparent from the present research that E

effects on S performance must be minimized. A step towards

this end would be to use Es who are not known to the Ss.

Certainly Es should not be co-workers, or have contact with Ss

beyond that which is actually necessary during the treatment

sessions themselves. An even better solution might be the

removal of E from the immediate stimulus environment while

Ss are being run. Stimulus item presentations could be pro-

grammed through the use of tape recorders, projectors, or

written instructions, and shock could be delivered remotely

through the use of one-way mirrors or automatic devices. The

use of "blind" Es -- those who do not know to which group a

given S has been assigned -- is also indicated. And, to the

degree that E-S contact is necessary, multiple Es could be utilized

for each S.







The treatment procedures themselves should be tightened

so that the contaminating effects of, e.g., reactive inhibition,

partial reinforcement, or delay of reinforcement are not intro-

duced. Towards this end, optimal interstimulus item intervals,

as well as the optimal number of stimulus item presentations

during each session, should be determined. With respect

to the number of treatment sessions actually needed, it will

be recalled that the results cited earlier indicated that

further reduction in smoking for the HI, H2, and H3 groups

was not significant beyond the eighth session-day. Perhaps

if fewer shock sessions, and/or a shorter experimental treat-

ment period had been incorporated into the present research

design, some of the resistance evidenced by many of the Ss

would have been circumvented.

Changes in the escape paradigm used in the present

study might also be considered in subsequent investigations.

Solomon (1964), among others, has pointed out that active

escape procedures are most effective when they eventually

lead to stable avoidance responding. For methodological con-

siderations--primarily, to insure that all Ss received the

same number of shock onsets during each treatment session--the

H2 group Ss could only terminate the shocks, not avoid them.

Perhaps the differential effects of the H2 group (escape)

procedure would have been more pronounced, then, if active

avoidance responding had been allowed to develop.

Finally, the findings and observations of the present

study point up the need for incorporation of a non-shock control


I-




72



group in future research attempts. The considerations of S

availability and time precluded the inclusion of such a group

here. Additionally, it was thought that the random shock

group would serve the same function. The results obtained

from a non-shock group would establish a more meaningful base

from which to compare the results obtained from the groups

utilizing shock. Most importantly, however, the results of

such a group might be most illuminating insofar as the issue

of the importance of relationship and motivational variables

for behavior change is concerned.














CHAPTER V

SUMMARY

In the majority of the published clinical aversive

conditioning studies, the treatment procedures have been based

upon a simple punishment model. That is, a short-duration

aversive stimulus (usually electric shock) has either been

paired with appropriate CSs, and/or the target behaviors them-

selves. The experimental learning and conditioning literature,

however, has indicated that increased and longer lasting be-

havior suppression would occur when procedures based upon an

escape paradigm are used. In addition, experimental findings

have also shown that aversive stimuli, randomly administered,

have little, if any, lasting suppressive effects on specific

ongoing behaviors. Since a comparison of the differential

suppressive effects of procedures based upon simple punishment,

escape, and random reinforcement paradigms has not been made

to date under clinical conditions, this study attempted to do

so.

The target behavior used was cigaret smoking, and the

aversive stimulus was electric shock. Thirty-two volunteers

who wished to stop smoking served as Ss during the course of this

investigation. All were between the ages of 25 and 49, smoked

between one and two and a half packs of cigarets per day,








and had been continuous smokers for at least four years prior

to their participation as Ss.

Initially, three experimental treatment groups based

upon the above mentioned paradigms were begun. Eight Ss were

randomly assigned to each as they became available. All Ss

attended 15 individual treatment sessions on a daily basis

(omitting weekends), and all received the same number of

stimulus item presentations and shock onsets during each

session. After the data collection phase had gotten under

way, a fourth (session-avoidance) group, whose Ss could miss

a scheduled shock session on any day immediately following a

day free of smoking, was initiated.

Both motoric and ideational type stimulus items related

to smoking behavior were used. The number of cigarets smoked

during each of the treatment session-days was recorded for

each S. Individual cigaret consumption scores were also

collected two, six, and 12 weeks after treatment termination.

The hypotheses predicted that the significantly largest

mean smoking reduction rate during both the treatment and

follow-up phases would be attained by the session-avoidance

group. This was to be followed, in decreasing order of procedu-

ral effectiveness, by mean smoking reduction rates of the

escape, simple punishment, and finally random shock groups.

It was additionally predicted that the session-avoidance, es-

cape, and simple punishment group mean consumption rates on

the last session-day, and two, six, and 12 weeks after treat-








ment termination, would be significantly lower than their

respective pre-treatment levels.

The results clearly showed that, in contradiction to

the hypotheses, the mean smoking reduction rates of the four

groups did not differ significantly from each other during

either the experimental treatment or follow-up periods. In

other words, each group procedure was essentially as effective

as any other in suppressing smoking behavior. Also, the mean

smoking reduction scores of all the groups on the last session-

day, and two, six, and 12 weeks after treatment termination,

were significantly lower than their pre-treatment levels.

The over-all smoking recovery trend evidenced during the follow-

up period was, however, pronounced.

While evidence suggested that uncontrolled variables

common to all four treatment groups were operating to effect

an over-all reduction in smoking, differential effects of the

treatment procedures themselves were not demonstrated.

It was hypothesized that the possible confounding

effects of reactive inhibition, intermittent reinforcement,

and adventitious respondent conditioning, which may have

been introduced by the procedures themselves, as well as re-

lationship and motivational factors, combined to effect the ob-

tained results.





































APPENDICES








APPENDIX A

TABLE 9


ANALYSIS OF VARIANCE OF AGE--GROUPS HI, H2, H3 AND H4
N = 32


Source of Variation df Mean Squares F P


Age, Between Groups 3 51.67 < 1.00

Age, Within Groups 28 76.71



TABLE 10

ANALYSIS OF VARIANCE OF THE PRE-TREATMENT MEAN NUMBER
OF CIGARETS SMOKED PER DAY--GROUPS HI, H2, H3, AND H4
N = 32


Source of Variation df Mean Squares F P


Cigarets per Day, 3 17.67 < 1.00
Between Groups

Cigarets per Day, 28 51.71
Within Groups



TABLE 11

ANALYSIS OF VARIANCE OF THE NUMBER OF YEARS A
CIGARET SMOKER--GROUPS HI, H2, H3,AND H4
N = 32


Source of Variation df Mean Squares F P


Years Smoked, Between 3 7.67 < 1.00
Groups

Years Smoked, Within 28 62.25
Groups
















U)I






0








S
























U)



0
U)
a










































0
UB




0
C-
0





0





H








M






U

&:


roorocoot
v 0 0 0 I


r -1 0 0 0 n r-I I
1-1 H-









0co0000)' o
-4- oom-4


0
















U)
L-4I
en








-,
CM





















i-l





0
0
3 "

mO
0
,.
-








U11


r-0 10 0 Lo
1-
m 0N








N0000 000
o 00 0 0 001





r- H r
c-10 o O t 0C


O 10 1 0 0 m 0N
C C~ OOtON





Hc OOO^OO
30 00 000
w00 0 0 00
-4000-00
N1O It 0 0 \O 0

rl l r-


co 00 00L00
) H M




LmmnooNoo
N 0-40
Nr-io r-(




'0 U)O 0 C 10 U) 0'



NM 0 ON o r- I 00 0
-41


-41

Ct o O C t l Nt O
0N O t0 00 00



1-0













dnoio IH
1-1 C in n rn (M (
i- pM c r iri )O c
dnojo T


C' co 0 LI 'T
0OCnOU)0





CM10 r-l C




dnoig ZH
00000


040ch


' 0@CLnr



000000"-




0000 0 \ ) 00 0

O I 0 m l


dONOO\0H0

OOvODOOcO'


CTO- 0 0 0 0 C,'
0' 0 U 0 0 \0 0 )
HH 1
omtioooo
0,000000


ootmoainoto
0 0 in 0 000m o
00U00U00


>0 0N c0 t--
-O'Dmt Io mot0
-4
000,-Im
000 Ht~\



r-l


i-i








o o0 t in co I
1-4


1-4

I N 'C n 'C U OO to








000-00C0H
U) N C N eI -4 C











dnoi3 H


00000



00000

0-000
H Ht H 00



0C0000
ONO O
r-q H -1 H







0U)0'C0
00000


00 0 CO 0
11 H H1



000C0

o0 C 00 0

0 CO O m N M
0000





c0000





0 r) N0
-4


H
000
)O00
r-l

'00 O
H-

COIno r-
-4




0 0
ooNN






mON

emmn
U00 0


0000
O r-CO












10 ,o in

























( f)




r Al rCO[-Ntl
o o,
o cc 4 t-%D N -q
H 0 H -wt D0I


N I r-A r-


In 0000000
Al oO O O(- 0o
r-I -I rA r- r-4 rl

U m0OOOOOC00O
H 0C 0OO0O0 ) OO



0) m OOO0 0 -1 o
:5 H OOO00O01O00
-1


Hl oo 0-G'moo00


LU 0 OO OOq

-1 0 0 'COC0OtOOO
al I ( i r-i rl



OI HI H HHH~ N O
(U CO 00000O00
>, UI 0000000
r( H H r--IH H H

0) OO O OCO C 0 O


Wcol 0000C0,c0O

Qo HHH H


H H H H-I r-q
I c %D all 0 0 t- 0 1 0 I




U) to0 0 0 t LIn

H- H H

H 4H


Co 0 oo00o tom

H H H
(1) If) )0 0 U) a ON
t- t- 0 c 0 Nd ~ v







L) t No o\ C 0LI ) H
In N Hooorlr








Hn\ sO H ~ 'H0'q



U)1
Cdloao V11








APPENDIX C

TABLE 13

THREE-DAY MEANS FOR EACH S COMPILED FROM THE ACTUAL NUMBERS OF
CIGARETS SMOKED BEFORE TREATMENT AND AT THE END OF FOLLOW-UP



Before Treatment After Follow-Up


31 25
28 11
25 24
HI Group 35 30
45 31
30 24
42 0
24 10

23 6
40 36
42 0
H2 Group 26 25
38 0
48 20
31 28
28 30

32 11
30 24
42 40
H3 Group 34 0
28 10
44 20
26 25
38 37

28 7
38 0
35 25
H4 Group 30 8
43 41
34 30
41 40
40 34














REFERENCES

Andrews, J. D. Psychotherapy of phobias. Psychol. Bull.,
1966, 66, 455-480.

Azrin, N. H. Punishment and recovery during fixed-ratio
performance. J. exp. Anal. Behav., 1959, 2, 301-305.

Azrin, N. H. Effects of punishment intensity during variable-
interval reinforcement. J. exp. Anal. Behav., 1960,
3, 123-142.

Bancroft, J. H., Jones, H. G., and Pullan, B. R. A simple
transducer for measuring penile erection, with comments
on its use in the treatment of sexual disorders.
Behav. Res. Ther., 1966, 4, 239-241.

Bandura, A. Punishment revisited. J. consult. Psychol., 1962,
26, 298-301.

Barker, J. C. Behavior therapy for transvestism: A comparison
of pharmacological and electric aversion techniques.
Brit. J. Psychiat., 1965, 111, 268-276.

Barker, J. C., Thorpe, J. G., Blackmore, C. B., Lavin, N. I.,
and Conway, C. G. Behavior therapy in a case of
transvestism. Lancet, 1961, 1, 510.

Blake, B. G. The application of behavior therapy to the
treatment of alcoholism. Behav. Res. Ther., 1965, 3,
75-85.

Blake, G. A follow-up of alcoholics treated by behavior therapy.
Behav. Res. Ther., 1967, 5, 89-94.

Brady, J. V. Ulcers in "executive monkeys." Scient. Amer.,
1958, 199, 95-103.

British Tuberculosis Association, Smoking deterrent study.
Brit. med. J., 1963, 2, 460-487.

Brown, J. S., Martin, R. C., and Morrow, M. W. Self-punitive
behavior in the rat: Facilitative effects of punishment
on resistance to extinction. J. comp. physiol. Psychol.,
1964, 57, 127-133.









Church, R. M. The varied effects of punishment on behavior.
Psychol. Rev., 1963, 70, 369-402.

Clark, D. F. Fetishism treated by negative conditioning.
Brit. J. Psychiat., 1963, 109, 404-407.

Coates, S. Clinical psychology in sexual deviation. In I.
Rosen (Ed.), The pathology and treatment of sexual
deviation, a methodological approach. London: Oxford
University Press, 1964.

Cooper, A. J. A case of fetishism and impotence treated by
behavior therapy. Brit. J. Psychiat., 1963, 109, 649-
652.

Estes, W. K. An experimental study of punishment. Psychol.
Monogr., 1944, 57 (3, Whole No. 263).

Eysenck, H. J. Behavior therapy, extinction and relapse in
neurosis. Brit. J. Psychiat., 1963, 109, 12-18.

Eysenck, H. J., and Rachman, S. Causes and cures of neurosis.
San Diego, Calif.: Robert Knapp, 1965.

Feldman, M. P. Aversion therapy for sexual deviations. Psychol.
Bull., 1966, 65, 56-79.

Feldman, M. P., and MacCulloch, M. J. The application of antici-
patory avoidance learning to the treatment of homosexual-
ity. Behav. Res. Ther., 1965, 2, 165-183.

Fine, B. J., Marchesani, M., and Sweeney, D. R. A bibliography
on the psychological aspects of smoking: January 1940
through September 1965. Psychol. Rep., 1966, 18, 783-
787.

Franks, C. M. Alcohol, alcoholism, and conditioning. J. ment.
Sci., 1958, 104, 14-33.

Franks, C. M. Behavior therapy, the principles of conditioning,
and the treatment of the alcoholic. Quart. J. stud.
Alc., 1963, 24, 511-529.

Franks, C. M. Conditioning techniques in clinical practice
and research. New York: Springer, 1964.

Franks, C. M., Fried, R., and Ashem, B. An improved apparatus
for the aversive conditioning of cigaret smokers.
Behav. Res. Ther., 1966, 4, 301-308.

Gantt, W. H. Experimental basis for neurotic behavior. New
York: Hoeber, 1944.








Goldiamond, I. Stuttering and fluency as manipulatable operant
response classes. In L. Krasner and L. P. Ullmann
(Eds.), Research in behavior modification. New York:
Holt, Rinehart and Winston, 1965.

Goodnan, L. S., and Gilm.-n, ^.., The pharmacological basis of
therapeutics. N : York: Macmillan, 1960.

Greene, R. J. Modification of smoking behavior by free operant
conditioning methods. Psychol. Rec., 1964, 14, 171-178.

Hammond, E. C., and Percy, C. Ex-smokers. N. Y. State J.
Med., 1958 (Sept.), 2956-2959.

Holz, W., and Azrin, N. H. Discriminative properties of punish-
ment. J. exp. Anal. Behav., 1961, 4, 225-232.

Holz, W., and Azrin, N. H. Interactions between the discrimina-
tive and aversive properties of punishment. J. exp.
Anal. Behav., 1962, 5, 225-232.

Hsu, J. J. Electroconditioning therapy of alcoholism. Quart.
J. Stud. Alc., 1965, 26, 449-459.

Hull, C. L. Essentials of behavior. New Haven: Yale Univer-
sity Press, 1951.

Karsh, E. Effects of number of rewarded trials and intensity
of punishment on running speed. J. comp. physiol.
Psychol., 1962, 55, 44-51.

Kimble, G. A. Hilgard and Marquis' conditioning and learning.
New York: Appleton-Century-Crofts, 1961.

Koenig, K. P., and Masters, J. Experimental treatment of
habitual smoking. Behav. Res. Ther., 1965, 3, 235-243.

Kushner, M. The reduction of a long-standing fetish by means
of aversive conditioning. In L. P. Ullmann and L.
Krasner (Eds), Case studies in behavior modification.
New York: Holt, Rinehart and Winston, 1965.

Kushner, M. and Sandler, J. Aversion therapy and the concept
of punishment. Behav. Res. Ther., 1966, 4, 179-186.

Lazarus, A. A. The results of behavior therapy in 126 cases of
severe neurosis. Behav. Res. Ther., 1963, 1, 69-79.

MacCulloch, M. J., Feldman, M. P., Orford, J. F., and MacCulloch,
M. L. Anticipatory avoidance learning in the treatment
of alcoholism: A record of therapeutic failure.
Behav. Res. Ther., 1966, 4, 187-196.









Maier, N. R. F. Frustration: The study of behavior without a
goal. New York: McGraw-Hill, 1949.

Martin, B. Reward and punishment associated with the same goal
response: A factor in the learning of motives.
Psychol. Bull., 1963, 60, 441-451.

Martin, B., and Ross, L. E. Consumatory response punishment.
J. comp. physiol. Psychol., 1964, 58, 243-247.

Masserman, J. M. Behavior and neurosis. Chicago: University
of Chicago Press, 1943.

Masserman, JA M., and Pectel, C. Neurosis in monkeys: A pre-
liminary report of experimental observations. Ann.
N. Y. Acad. Sci., 1953, 56, 253-265.

Matterazzo, J. D., and Saslow, G. Psychological and related
characteristics of smokers and nonsmokers. Psychol.
Bull., 1960, 57, 493-513.

McGuire, R. J., and Vallance, M. Aversion therapy by electric
shock. Brit. med. J., 1964, 1, 151-153.

McNamara, H. J., and Wike, E. L. The effects of irregular
learning conditions upon the rate and permanence of
learning. J. comp. physiol. Psychol., 1958, 51, 363-366.

Mees, H. L. Sadistic fantasies modified by aversive conditioning
and substitution: A case study. Behav. Res. Ther.,
1966, 4, 317-320.

Meyer, V. and Crisp, A. H. Aversion therapy in two cases of
obesity. Behav. Res. Ther., 1964, 2, 143-147.

Meyer, V. and Crisp, A. H. Some problems in behavior therapy.
Brit. J. Psychiat., 1966, 112, 367-381.

Meyer, V., and Gelder, M. G. Behavior therapy and phobic
disorders. Brit. J. Psychiat., 1963, 109, 19-28.

Miller, N. E. Learning resistance to pain and fear: Effects
of overlearning, exposure, and rewarded exposure in
context. J. exp. Psychol., 1960, 60, 137-145.

Mowrer, O. H. Learning theory and behavior. New York: John
Wiley and Sons, 1960.

Muenzinger, K. F., Bernstone, A. H., and Richards, L. Motivation
in learning: VIII. Equivalent amounts of electric
shock for right and wrong responses in a visual dis-
crimination habit. J. comp._physiol. Psychol. 1938,
26, 177-186.








Muenzinger, K. F., and Powloski, R. E. Motivation in learning:
X. Comparison of electric shock for correct turns in
a corrective and non-corrective situation. J. exp.
Psychol., 1951, 42, 118-124.

Ober, D. C. The modification of smoking behavior. Unpublished
doctoral dissertation, Sniversity of Illinois, 1967.

Oswald, I. Induction of illusory and hallucinatory voices.
J. ment. Sci., 1962, 108, 196-212.

Prince, A. I. Effect of punishment on visual discrimination
learning. J. exp. Psychol., 1956, 52, 381-385.

Pyke, S., Agnew, N.M., and Kopperud, J. Modification of an
overlearned maladaptive response through a relearning
program: A pilot study on smoking. Behav. Res. Ther.,
1966, 4, 197-203.

Rachman, S. Aversion therapy: Chemical or electrical?
Behav. Res. Ther., 1965, 2, 289-299.

Raymond, M. J. Case of fetishism treated by aversion therapy.
Brit. med. J., 1956, 2, 854-857.

Rosenthal, R. Experimenter effects in behavioral research.
New York: Appleton-Century-Crofts, 1966.

Sanderson, R. E. An investigation of a new aversive conditioning
therapy for alcoholism. Creative talents awards pro-
gram, Series 3. Washington: American Institute for
Research, 1963, 39-43

Sandler, J. Masochism: An empirical analysis. Psychol.
Bull., 1964, 62, 197-204.

Skinner, B. F. Walden two. New York: Macmillan, 1948.

Skinner, B. F. Science and human behavior. New York: Macmillan,
1953.

Smoking and health: Report of the advisory committee to the
Surgeon General of the Public Health Service. Washing-
ton, D. C.: U. S. Dept. Hlth., Educ. and Welf., 1964.
(P. H. S. Publ. No. 1103)

Solomon, R. L. Punishment. Amer. Psychol., 1964, 19, 239-253.

Solomon, R. L., and Wynne, L. C. Traumatic avoidance learning:
Acquisition in normal dogs. Psychol. Monogr., 1953,
67, 1-19.

Tate, B. G., and Baroff, G. S. Aversive control of self-
injurious behavior in a psychotic boy. Behav. Res.
Ther., 1966, 4, 281-287.









Thorndike, E. L. Reward and punishment in animal learning.
Comp. Psychol. Monogr., 1932, 8 (Whole No. 39).

Thorpe, J. G., and Schmidt, E. Therapeutic failure in a case
of aversion therapy. Behav. Res. Ther., 1963, 1, 293-
296.

Thorpe, J. G., Schmidt, E., Brown, P. T., and Castell, D.
Aversion-relief therapy: A new method for general
application. Behav. Res. Ther., 1964, 2, 71-82.

Thorpe, J. G., Schmidt, E., and Castell, D. A comparison of
positive and negative aversivee) conditioning in the
treatment of homosexuality. Behav. Res. Ther., 1963,
1, 357-362.

Turner, L. H., and Solomon, R. L. Human traumatic avoidance
learning: Theory and experiments on the operant-
respondent distinction and failures to learn. Psychol.
Monogr., 1962, 76 (Whole No. 559).

Wilde, G. J. S. Behavior therapy for addicted cigarette
smokers: A preliminary investigation. Behav. Res.
Ther., 1964, 2, 101-109.

Wolpe, J. Conditioned inhibition of craving in drug addiction:
A pilot experiment. Behav. Res. Ther., 1965, 2, 285-
288.

Woodworth, R. S., and Schlosberg, H. Experimental psychology.
New York: Holt and Co., 1958.










BIOGRAPHICAL SKETCH

Michael Samuel Stokols was born in Chicago, Illinois,

on September 11, 1938, and mo4ed to Miami, Florida, with his

family at the age of six. lie graduated from Miami Senior High

School in 1956, attended the University of Florida from

September, 1956 to June, 1958, and received the Bachelor of

Arts degree with a major in Psychology and minor in Biology from

the University of Miami (Florida) in January, 1960. Mr. Stokols

entered the Graduate School of the University of South Carolina

in February, 1961, and received the Master of Science degree in

Psychology from this institution in August, 1962. Since entering

the Gradiate School of the University of Florida in September,

1962, he has been engaged in fulfilling the requirements for

the degree of Doctor of Philosophy in Clinical Psychology.

Mr. Stokols' financial support while at the University

of Florida has included an assistantship in the Reading Clinic,

traineeships through the Department of Vocational Rehabilitation,

and participation in the Veterans Administration Psychology

Assistantship Program. In May, 1967, he completed a predoctoral

internship in clinical psychology at the Edward G. Hines

Veterans Administration Hospital, Hines, Illinois. Mr. Stokols

is presently employed as a Clinical Psychologist, Level III,

at the Illinois State Pediatric Institute, Chicago, Illinois.








This dissertation was prepared under the direction of
the chairman of the candidate's supervisory committee and has
been approved by all members of that committee. It was sub-
mitted to the Dean of the College of Arts and Sciences and
to the Graduate Council, and was approved as partial fulfill-
ment of the requirements for the degree of Doctor of Philosophy.

December, 1968



Dean, Colleg /o-Artj and Sciences



Dean, Graduate School
Supervisory Committee:


(Ch / /mln
Chairman


\A_
^^^L^^






ilW-TL ~\ ^ wj^^--




Full Text

PAGE 1

A COMPARISON OF THE DIFFERENTIAL EFFECTS OF FOUR AVERSIVE PROCEDURES UTILIZING ELECTRIC SHOCK ON SMOKING BEHAVIOR By MICHAEL SAMUEL STOKOLS A DISSERTATION PRESENTED TO TIIE GRADUATE COUNCIL OF THE UNR'EESITY OF FLORIDA IN PARTIAL FULFILLMENT OF THE REQUffiEMENTS FOR ITIE DEGREE OF DOCTOR OF PHILOSOPHY UNIVERSITY OF FLORIDA 1968

PAGE 2

UNIVERSITY OF FLORIDA 3 1262 08552 4139

PAGE 3

ACKNOWLEDGMENTS I would like to express my deep appreciation to the Chairman ox my Dissertation Committee, Dr. William Wolking, for his encouragement J understanding, and valuable assistance during the completion of this research. I would also like to convey my thanks to the other members of my committee, Drs . Henry Pennypacker, Hugh Da^vis, Paul Satz , and Ellsworth Bourque, for their valua.ble help and advice. A special noteof gratitude is also due Dr. Roy Brener, Chief, Psychology Service, and the Research Council of the Edward G. Hines Veterans Administration Hospital, Hines, Illinois, for granting me the necessary research time and facilities for the apparatus construction and data collection phases of this investigation. Finally, I would like to thank the men and women--for the most part, st£iff members at Hines--who partd cip£>.ted as subjects in this study.

PAGE 4

TABLE OF CONTENTS ACKNOWLEDGMENTS . . . LIST OF TABLES . . . LIST OF FIGURES. . . Chc'ipter I . INTRODUCTION Page A Formulation of the Problem 4 Punishment asid the Clinical Literature. ... 7 The Problem Behavior: Smoking 19 The Hypotheses Under Investigation 25 1 1 . METHOD 30 Subjects 30 Apparatus 31 Procedures 34 III. RESin.TS. 45 IV. DISCUSSION 58 Confounding as a Function of the Procedures . 59 Situational Variables as a Source of Confounding 62 Some Issues for Future Research 69 V. SU^^1ARY 73 APPENDICES 76 REFERENCES 81 BIOGRAPHICAL SKETCH 87

PAGE 5

LIST OF TABLES Tabic Pa^^ 1. Stimulus Items, Shock Points, and Representative Escape Responses. . . . • 37 2. Repeated Measurements Analysis of Variance of the MPSR Scores Across Session-Days --Groups HI, H2 , and H3 N =^ 24 48 3. Neuraan-Keuls Test of all Ordered Pairs of SessionDay Means for Groups HI, H2 , and H3 50 4. Repeated Measurements Analysis of Variance of the MPSR Scores Across Session-Days--Groups HI, H2 , H3, and H4 N 32 51 5. Analysis of Variance of the MPSR Scores on the 15th Session-Day--Groups HI, H2 , and H3 N = 24 52 6. Analysis of Variance of the MPSR Scores on the 15th Session-Day--Groups HI, H2 , H3 , and H4 N = 32, . , 53 7. Repeated Measurements Analysis of Variance of the MPSR Score-s Two, Six, and 12 Weeks After Treatment Termination-Groups HI, H2 , H3 , and H4 N = 32 54 8. Neuman-Keuls Test of all Ordered Pairs of FollowUp Means for Groups HI, H2 , H3 , and H4 55 9. Analysis of Variance of Age--Groups HI, H2 , H3 , and H4 N = 32 77 10. Analysis of Variance of the Pre-Treatment Mean Number of Cigarets Smoked per Day--Groups HI, H2 , H3 , and H4 N = 32 77 11. Analysis of Va.riance of the Number of Years A Cigarot Smoker --Groups HI, H2 , H3 , and H4 N = 32 . 77 12. Per Cent Smoking Reduction Scores Across Experimental Treatment and Follow-Up Periods --All S s . . . 78 13. Three-Day Means for Each S^ Compiled from the Actual Numbers of Cigarets Smoked Before Treatment a.nd at the End of Follow-Up ' 80

PAGE 6

LIST OF FIGURES Figu re Page 1. HI, H2, H3, and H4 Group MPSR Scores Across the ExTperlmental Treatment and Follor-Up Periods ... 47

PAGE 7

CHAPTER I INTRODUCTION While punishment training has been the least utilized behavior therapy method to date, a review of the recent literature does indicate that this method, often referred to as aversive conditioning, is finding increased favor among behavior modifiers. Nevertheless, many clinicians of varied theoretical persuasions continue to doubt the effectiveness of punishment training, viewing its use in clinical situations with serious misgivings. The reasons underlying such attitudes are numerous, and several likely ones will be mentioned here. Before proceeding, however, a definition of punishment, as it pertains to this study, is in order. Punishment, then, has been defined as: (1) some physically aversive or noxious stimulus which is either contiguous with a CS, or contingent upon the performance of some behavior (Church, 1963); and (2) a stimulus which a subject (S) will reject if given a choice between it and no stimulus at all (Solomon, 1964). Thus, such procedures as, e.g., verbal disapproval, restraint, the withholding of positive reinforcement, time-outs, or massed practice, while they may properly fall under the general rubric of negative reinforcement, will not be considered punishment in this narrower sense.

PAGE 8

As Solomon (1964) has pointed out, a large number of clinicians undoubtedly feel that punishment just does not work; that its effects are transient, unstable, inconsistent, and do not really weaken habits. The therapist who has his doubts about the effectiveness of punishment is in good company. Many prominent psychologists have disavowed punishment as having any lasting suppressive effects on behavior (e.g., Bandura, 1962; Estes, 1944; Skinner, 1948, 1953; Thorndike, 1932). Many writers and editors of texts dealing with the areas of learning and conditioning devote but a few lines to the problem of punishment (e.g., Hull, 1951; Kimble, 1961; Woodworth and Schlosberg, 1958). Solomon points out that many contemporary introductory psychology texts devote scant space to punishment as a scientific problem, citing as a case in point George Miller's recent text. Psychology, the Science of Mental Life , which contains no discussion of punishment anywhere. The state of the experimental learning literature is in itself most confusing, and undoubtedly contributes in no small measure to the negative feelings many clinicians hold towards the use of punishment in clinical situations. While much experimental evidence indicates that punishment decreases the probability of a response occurring, contrary experimental results, often referred to as "paradoxical effects," are legion (refer to articles by Church, 1963; Kushner and Sandler, 1966; Martin, 1963; Sandler, 1964; and Solomon, 1964). For example, several studies have shown that when punishment is correlated with positive reinforcement during acquisition trials, punishment-

PAGE 9

extinction trials produce an increase in responding over conditions of regular extinction; also, there is usually increased resistance to extinction (Carlsmith, mentioned by Solomon, 1964; Holz and Azrin, 1961, 1962; Martin and Ross, 1964), Karsh (1962) found that punishment , if introduced before the asymptotic performance under regular training has been reached, may well induce further improvement under the punishment procedure. Azrin (1959, 1960) found that when mild punishment of an instrumental response acquired under positive reinforcement is terminated, there is often a temporary increase in response rate over that which would have occurred without punishment. Several researchers have reported that increased learning in selective learning situations often obtains when "right" responses are punished (Muenzinger et al . , 1938; Muenzinger and Powloski, 1951; Prince, 1956). And, there have been studies showing that, under certain conditions, Ss prefer continued exposure to punishment , even though non-punishing alternatives are available (Brown et al . , 1964; Sandler, 1964). While many more examples could be given, perhaps Church (1963) best summed up the "paradoxical" literature with his observation that punishment, under particular circumstances, might result in almost any conceivable effect . Solomon (1964) also suggests that the fear of unwanted emotional side effects, often produced in the laboratory, has probably deterred many therapists from making use of punishment procedures. Many animal studies have, in fact, produced highly disturbed S^s (e.g., Brady's [1958] work with ulcerous

PAGE 10

monkeys; Gantt's tl944j work with neurotic dogs; Maier's |_1949J work with fixated rats; Masserman's [1943] work with neurotic cats and nonkeys; and Masserman and Pectel's fl953j work with monkeys). Among others, such factors as high stimulus intensities, the punishment of consummatory and instinctive behavior, punishment under non-discriminatory control, the unavoidability of punishment, and the punishment of responses acquired under negative reinforcement all seem to contribute towards such results. Finally, but perhaps most importantly, the often ambiguous and inconclusive results of many of the published clinical studies and case reports using punishment as tlie treatment variable have, in all probability, discouraged many therapists from making use of punishment training procedures. Before turning to relevant examples of this literature, however, the major focus of this study will first be considered. A Formulation of the Problem In the majority of the clinical cases which have utilized a punishment paradigm, the major underlying assumption seems to have been the following: that the simple pairing of a short-duration noxious stimulus with either a presenting stimulus (the CS ) or an elicited response would be sufficient to insure the subsequent lasting suppression of the target behavior in question. While the emphasis seems to have been focused on the problem of obtaining response suppression -i.e., getting the patient not to do somoth^ing -relatively

PAGE 11

little experimental literature is available concerning the problem facing the clinician of systematically getting the patient to do something else instead . This issue is certainly familiar to the laboratory investigator studying escape and avoidance learning. In such experiments the design usually provides for the development of alternative instrumental escape and avoidance behaviors as a way of averting or attenuating the noxious stimulus. Solomon (1964) has stated: "Punishment becomes extremely effective when the response-suppression period is tactically used as an aid to the reinforcement of new responses that are topographically incompatible with the punished one" (p. 241). One way to achieve this end would be to use the noxious stimulus itself as a reinforcer for new behavior judged to be incompatible with the punished response. If cessation of shock is made contingent upon the occurrence of an operant, this escape response will be reinforced. Soon, escape and then avoidance responses should be occurring in stable fashion immediately upon presentation of the stim.ulus pattern(s) which formerly elicited the punished response. Mowrer (1960) calls such learning "active avoidance learning" and presents several examples illustrating this paradigm in his book. Learning Theory and Behavior . Turner and Solomon (1962) using human S s , and electric shock as the UCS, shoiv-ed the effectiveness of making cessation of long-duration shock contingent upon deliberate,

PAGE 12

voluntary operants (as opposed to short -latency reflexive responses) for escape and avoidance learning. Of course, the behavior therapist is primarily concerned with the suppression of unwanted behavior, and Turner and Solomon did not concern themselves with response suppression, per se, in their monograph. However, it could reasonably be expected that by combining in treatment what the behavior therapist employing punishment training attempts to do -that is, foster response inhibition as a result of the negative conditioned emotional response which develops when punishment is made contingent upon a response -with what Solomon (1964) suggests be done -that is, sequentially reinforce an operant response incompatible with the punished response -far more effective and longer lasting response suppression should occur. While this procedure is well known in the experimental literature, many clinicians have either ignored such an approach, or have made relatively little systematic use of this tactic in their treatment of patients. This has been especially true in the many instances where drugs have been employed as the avers sive stimulus. A major intent of this study, then, v;ill be the attempt to demonstrate clinically whether a long-duration noxious stimulus employed in the manner suggested above would, in fact, be more effective in inducing lasting response suppression than the same stimulus of short duration simply paired with the target response, or the CS(s) eliciting such behavior. And, the experimental learning and conditioning findings have also overwhelmingly indicated that non-contingent or randomly

PAGE 13

administered stimuli -either positive or negative -have little lasting suppressive or facilitative effects on behavior. All clinical attempts utilizing aversive conditioning methods have at least assumed this much in the design of the treatment procedures. To this end^ then, the attempt to demonstrate that a short -duration noxious stimulus presented randomly would not have any lasting suppressive effect on a given response pattern, will also be made. The results of such a demonstration should establish a more meaningful base from which to view the data obtained from the above mentioned comparison. Punishment an d the Clinical Literature Choice of the Noxious Stimulu s By far, the majority of the published aversive conditioning studies have concerned themselves with the treatment of alcoholism and the sexual deviations. In most cases the aversive stimulus has been an emetic drug such as apomorphine or em.etine, and, by and large, conditioning principles have been violated in many instances (Eysenck, 1963; Franks, 1958, 1963; Rachman, 1965). Apparently some clinicians have given the patient alcohol (the CS ) after the patient reached the height of nausea (backvjard conditioning), time intervals between presentation of the various stimuli have not been controlled, and the nausea-inducing drugs may have acted as central depressants, thereby possibly interfering with the acquisition of the conditioned responses (Eysenck and Rachman, 1965). Others have focused on the act of vomiting rather than the feeling of nausea as the CS, and individual reactivity to the drugs has been a

PAGE 14

confounding factor (Barker et al . , 1961). Sanderson (1963) notes that the reaction to apomorphine is too gradual and too irregular to meet the requirements of a good UCS. Also, the use of emetic drugs as aversive stimuli is: (1) cumbersome and messy; (2) involves undue man-hours, expense, and effort; and (3) often necessitates the taking of exacting medical precautions including hospitalization to insure the safety of the patient ( Rachman , 1965). Cases in point are the studies of Clark (1963), who treated a case of fetishism; Sanderson et al . , who treated alcoholics (reported in Franks, 1964); Raymond (1956), who treated a case of handbag fetishism and perambulator destruction; Cooper (1963), who treated a case of impotence and fetishism; and Barker (1965) and Barker et a l. (1961), who treated cases of transvestism. Cooper's paper in particular dramatically points out the degree to which patients undergoing this kind of treatment are physically debilitated, fatigued, and endangered. Thus, in this study, electric shock was used as the noxious stimulus of choice. Not only can electrical stimulation be more precisely controlled, it can be delivered at a determined intensity for an exact duration of time at precisely the required moment. And, not only does electric stimulation avoid many of the disadvantages of the emetics listed above, it has the added advantages of not requiring medical supervision nor more than one person in its administration (Barker, 1965; McGuire and Vallance, 1964; Rachman, 1965). Further, from the

PAGE 15

personal clinical experience of E with this method, and from experience directly related to this study, it has been observed that, while most patients or Ss have not liked the experience of getting shocked, none exhibited intense fear reactions or immobilization to the procedure. And, lastly, the vast majority of the studies in the experimental punishment literature have used electric shock as the aversive stimulus, thus providing the clinician with a wealth of potentially valuable experimental data. Thus, only aversive conditioning studies which have employed shock as the noxious stimulus will be mentioned here. Clinical Studies Using Electric Shock Thorpe et al . (1963) administered shock to a homosexual patient through a grid on the floor after two non-aversive procedures with the same patient had failed to bring about any change in his behavior. Using a VI/VR reinforcement schedule, shock, presumably of short duration, closely followed the illumination of a photograph of a nude male on approximately one quarter of the presentations. The patient received a total of 100 trials, each consisting of 40 illuminations. Follo-vV-up apparently showed that, at best, the patient could be considered bisexual rather than exclusively homosexual. Using essentially the same procedure with another homosexual, Thorpe and Schmidt (1963) reported in the same volume that the patient terminated treatment after three sessions over two days. This case was deemed a failure. McGuire and Vallance (1964), also following a simple punishment model, reported treating cases involving fetishism.

PAGE 16

10 smoking, writer's cramp obsessional ruminations, and alcoholism. They indicated that just over 50 per cent of these patients (N = 39) improved sufficiently to receive a "good improvement" or "symptom removed" rating at the end of treatment. Apparently, the authors encouraged their patients to administer their own shock, both during treatment sessions and at home. Mees (1966) recently reported in great detail the treatment of a case of sadistic fantasies in a 19-year-old male. After 25 weeks of baseline data collection, short-duration shock was delivered to the fingers when the patient imagined selected parts of his fantasy. Over 6,000 shocks during 65 sessions were given during the 14— week treatment period. Follow-up 11 weeks later indicated that the patient's sadistic fantasies accompanying masturbation had markedly decreased and that heterosexual fantasies v;ere increasing. Like the patients of McGuire and Vallance above, Mees' patient began shocking himself during the second week of punishment training, sometimes for periods up to two hours. VJolpe (1965) also reported that a physician with drug addiction of three years' standing was able to "significantly reduce" his cravings with only nine "distinctly strong" shocks which were self-administered over approximately a three-week period. Three months later, however, there was a complete relapse and drug talking resumed unabated. Feldman (1966) criticizes the procedure of allowing the subject to shock himself on the grounds that punishment may become sought after; i.e., may become positively reinforcing, especially

PAGE 17

11 if the patient is free to set his own intensity level. Sandler's (1964) concept of masochism, defined as the situation in which a noxious stimulus does not result in avoidance behavior being exhibited by the S^ receiving it, might also be relevant here. Kushner (19G5), and Kushner and Sandler (1966), refer to a fetishist who was treated along simple punishment lines, for the most part. Shock of short duration was paired with the patient's images of himself engaging in various aspects of his fetishist activity, presentation of the fetishist object (woman's panties), and the presentation of a sexually arousing picture. An 18-month follow-up showed the patient to be essentially free of his fetishist behavior. The latter study (Kushner and Sandler, 1966) also reported the treatment of an obsessive suicidal rurainator, an occupational compulsive hand contractor, and an exhibitionist with short -duration shock. Follow-up (12 months) indicated complete suppression of the exhibitionist activity, moderate success in the case of the suicidal ruminator (three-month follow-up), and little if any improvement on the job after 101 shock sessions for the hand contractor. The last-mentioned patient's teletypewriter performance was much improved during treatment sessions, however, Thorpe et al . (1964) used a technique which they called "aversion relief therapy" in treating three "homosexuals" (two were called latent), one fetishist, one phobic, one obsessivecompulsive, and one depressive compulsive eater. Using 24

PAGE 18

12 words on a disc appropriate to each patient's problem as the CSs , they presented each word in turn, pairing it with short-duration shock to the feet. The last word -e.g., in the case of a homosexual it might be "heterosexual" -was not shocked and thus was the "relief" word, as it signaled the end of the trial. While results of this study were ajnbiguous as presented, all the patients seemed to be improved to some degree immediately following treatment, with the exception of the obsessive-compulsive and the compulsive overeater. Both of these patients terminated treatment. Since only very brief follow-ups were given, little can be said about the efficacy of this particular brand of punishment training. Meyer and Crisp (1964) reported treating two obese women with shock, but the exact procedures are anything but clear. Certain foods were displayed in the sam.e room with the patient, and shock was contingent upon actual movement by the patient towards the "temptation" food. The shocks ceased when the patient ceased moving towards the food, and apparently could be avoided entirely during any given session. The authors report one success and one failure but leave unanswered questions pertaining to, e.g., shock duration and number, whether the reinforcement contingency was completely controlled by the S_, whether gross movement toward the "temptation" food ivas the only experimental response focused on, or how much time the patients spent in the treatment rooms. Through the use of short -duration response-contingent shock (onset sometimes delayed up to 30 seconds, though) Tate

PAGE 19

13 and Baroff (1966) deconditioned acute self -injurious behavior (SIB) in a hospitalized psychotic boy over a period of five months. Eventually, just the threat of shock was sufficient to produce a reduction in other unwanted behavior such as posturing and not eating. Withdrawal of physical contact ("timeout") was previously used as the negative reinforcement, but shock was found to be far more effective in suppressing the unwanted behavior. The authors refer to a paper read by Lovaas et al . , and a personal communication by Ball, all of v/hom used similar shock procedures to successfully suppress SIB in several schizophrenic children and a severely retarded girl, respectively. Bancroft et al . (1966) recently reported treating a pedophiliac with electric shock over a 38-day period. Briefly, the patient was told to concentrate on sexually stimulating fantasies after viewing pictures of children. When an erectile response occurred, which registered on a specially constructed transducer, shock was administered to his arm. Once in every four trials, the shock box was disconnected, and the patient was given pictures of adult women and encouraged to produce an erection with heterosexual fantasies. After an 18-month follow-up period, the patient continued to display a variety of sexual difficulties although pedophilia was no longer the m.ajor problem. Hsu (1965) placed a tray containing six one-ounce plastic cups filled xvith beer, wine, whiskey, milk, water, and fruit juice in front of alcoholic patients, and then as

PAGE 20

14 each alcoholic drink was swallowed, an electric shock, 30 seconds in duration, was administered. After completion of the five-day treatment sequence, the patient was released from the hospital with the provision that he return for twoday booster treatments at four-week and six-month intervals. The results of this treatment procedure were ambiguous. First, Hsu used "out of the hospital working or seeking employment" as the criterion measure for treatment effectiveness, not the decrease or absence of further drinking behavior. Secondly, Hsu failed to provide clear-cut follow-up data. It was simply reported that of 40 patients who received treatment, 20 failed to complete the initial five-day sequence or the first reinforcement booster treatment. The other 20 patients did at least get that far, and of these, 13 were simply described as being "out of the hospital working or seeking employment." There were other puzzling aspects to this study. Hsu's placement of the electrodes above both ears of his patients was, to say the least, atypical and without precedent or subsequent imitation in the recent aversive conditioning literature. The patients' reactions to the shock stimulus were also atypically severe. Many patients exhibited marked physical responses such as foot stamping, hand trembling, crying and screaming, nausea and vomiting. Others reported feeling head pain and seeing "flashing lights." Finally, the duration of the shock -30 seconds -was not explained on theoretical or empirical grounds, and shock cessation was not contingent upon any particular response or stimulus event.

PAGE 21

15 Very few of the aversive procedures cited in the foregoing case reports have seemed to be rooted very deeply or systematically in the general body of the experimental psychology of learning. Certainly none of these papers systematically provided for the development of alternative and more desirable escape and avoidance behavior by utilizing the positive reinforcing effects of response-contingent shock cessation. Several studies employing shock as the noxious stimulus have, however, evidenced their greater awareness of these procedural considerations, and to these attention will now be turned, Blake (1965), working with some 50 to 60 fee-paying alcoholics, has attempted to test the efficacy of "straight" aversive conditioning against the same aversive procedures following deep muscle relaxation training. Blake argued that because alcoholic behavior is often motivated and accompanied by high drive (anxiety or fear), the effects of aversive conditioning would be enhanced if the S_ could approach the treatment situation in a state of low drive. Also, motivational efforts would be more effective while the patient was deeply relaxed. In a recent paper, Blake (1967) has published 12month follow-up data for both groups. The results show that 59 per cent of the relaxation-aversive group (N = 37) and 50 per cent of the straight aversive group (N = 25) were classified as either "abstinent" or "improved." The difference is not statistically significant though. Of major interest for the

PAGE 22

16 present study, however, was the aversive procedure used by Blake which incorporated escape from shock. S^s were given the necessary ingredients to mix a drink according to taste, and then were shocked on a 50 per cent reinforcement schedule as they sipped (without swallowing) the liquid, presumably on command. Shock could be terminated by spitting out the alcohol. On non-reinforced trials, the alcohol was ejected in response to a light signal. The number of conditioning sessions was not controlled, and they varied over a four-to eight -day period. In reviewing the various forms of punishment training in the aversive conditioning literature, Feldman and MacCulloch (1965) concluded that anticipatory avoidance learning -a situation wherein the S^ can prevent the occurrence of the noxious stimulus (the UCS ) by performing an instrumental response to the CS -was particularly resistant to extinction. Support for this position, as mentioned previously, has been amply demonstrated by Solomon and Wynne (1953), Turner and Solomon (1962), and Solomon (1964). In their ivork with homosexuals, Feldman and MacCulloch constructed two hierarchies, one comprising slides of nude and clothed m.ales in ascending order of attractiveness, and the other of females in the reverse order of attr^^ctiveness . Briefly, a male slide (starting with the least attractive) was presented on a screen, and if the S_ did not switch off the slide within eight seconds, he received a shock. The

PAGE 23

shock stimulus was terminated when the illuminated slide was finally switched off. Introduction of the appropriate female slide (initially, the most attractive) was made contiguous with the removal of the male 3»lide on many trials. The therapist controlled the removal of the female slide, but the S could ask for its return. This request, randomly met by the therapist, was increasingly made, as the presence of the female slide acted to delay the reappearance of a male slide. About 30 trials per session were given, but the number of sessions varied from five to 28. "Booster" sessions were also administered during the follow-up period. Of 19 homosexuals treated at the time of publication, three failed to complete the procedures, six showed little, if any, improvement , and ten have altered their sexual orientation to some clinically significant degree. Follov;-ups ranged from one month to 14 months. Most interestingly, MacCulloch et al . (1966), using the same methodology as that described above for Feldman and MacCulloch, treated four alcoholics, all of whom returned to their previous drinking behavior following treatment. In assessing these failures, the authors questioned whether their patients' drinking behavior was any longer axmenable to psychological control, due to the possible development of a pathological biochemical necessity for alcohol. It should be noted, however, that motor, gustatory, and olfactory components of the drinking response -e.g., sipping, tasting, and smelling the

PAGE 24

18 alcohol -were not shocked as part of treatment , as occurred in Blake's (1965) procedures with alcoholics. Instea.d, MacCulloch et al . relied almost entirely on visual stimuli such as slides of alcohol, and alcohol in a bottle and a glass in the S ' s visual field. And, in like vein, it might be hypothesized that Feldman and MacCulloch's moderate success with homosexuals may have been occasioned by the very fact that the visualperceptual mode plays a more vital part in the arousal and precipitation of homosexual behavior than it does for alcoholic behavior. In summary, then, the case reports and studies mentioned so far have all used electrical stimulation as the noxious stimulus, and all have attempted to suppress some undesirable or unacceptable behavior-complex judged to be the result of maladaptive learning. In addition, a relative few have attempted to reinforce alternative behavior deemed incompatible with, and preferable to, the punished behavior -at least to some degree. Beyond this, little in the way of comparison can be said. Various rationales and justifications purportedly based on experimental evidence have been offered, as well as a variety of classical and instrumental punishment procedures -some simple and some more complex. Treatment intensities, controls, and lengths have varied. The patients and their behavioral syndrom.es, as well as treatment results, and follow-up procedures and lengths a^re not comparable. Often, follow-up data have not been offered at all. Rachman's (1965) Table 1 shows, for example, that of 114 persons reported in the literature who

PAGE 25

19 were treated with aversive conditioning procedures using electric shock for a variety of behavior disorders , 40 per cent were not followed past treatment termination. Most importantly, however, the clinical literature offers little, if any, evidence bearing on the issue of whether the reinforcement of an appropriate escape response through long-duration electric shock cessation is more effective in establishing lasting behavior suppression than short-duration shock which is simply contiguous with a CS or target response. And, in no study to date has the noxious stimulus been administered in completely random fashion, either for control or treatment purposes. With the above in mind, and before proceeding with a more formal statement of the hypotheses under investigation, attention v/ill first be turned to the specific behavior syndrome dealt with in this study. The Problem Behavior; Smokin g The target behavior selected for deconditioning was cigaret smoking. This habit appeared to be a satisfactory compromise between using a behavior syndrome of full clinical proportions such as alcoholism, with all the attendant problems for S^ selection, experimental control, and treatment which would have been entailed, and a non-clinical contrived response such as lever pressing which could have been conditioned before punishment training began. With a target response such as lever pressing, generalizability of results to clinical situations and problems would have been limited.

PAGE 26

20 Koenig and Masters (1965) list three criteria which should be satisfied in selecting a behavior for clinical experimentation: 1. The behavior should have the characteristic of maladaptiveness to keep within the paradigm of neurotic behavior. 2. The behavior must be potentially observable and occur in discriminable units. 3. The behavior should ideally occur with a fairly high frequency in the population at large. Cigaret smoking appears to satisfy all three. It is an entrenched habit that has proved to be extremely difficult to modify for many smokers. Ihe smoker is constantly being urged to maintain his habit by virtue of the massive and ubiquitous advertisement caimpaigns the cigaret manufacturers conduct. Smoking is socially acceptable, and the healthhazard issue raised by numerous investigations -in particular, the Surgeon General's report (Smoking and Health, 1964) -linking cigaret smoking with lung cancer and a variety of other disease states, has apparently proven to be an insufficient deterrent. Hammond and Percy (1958) found that of 333 exsmokers identified in a random telephone directory sample of 3,560 smokers and ex-smokers, only 8.7 per cent had quit because of health concerns. However, 62.5 per cent of the exsraokers had given up the habit because of some condition, such as coughing or throat irritation, made worse by smoking. Apparently, the threat of lung cancer or some other disease, while seemingly a most powerful deterrent, is too far removed

PAGE 27

21 in time as a consequence of smoking to be a very effective negative reinforcer. A great deal of effort has been expended investigating the psychological characteristics of smokers and non-smokers. As an illustration of this research activity. Fine et al , (1966) recently compiled a bibliography on the psychological aspects of smoking consisting of 143 studies conducted from January 1940 through September 1965. Matterazzo and Saslow (1960), in their extensive review of the literature, found that while smokers -particularly heavy smokers -and non-smokers differed on some 30 variables, none of the studies offered a single variable found exclusively in one group but absent in the other. The authors concluded that smokers seem to be slightly more neurotic, on the average, than non-smokers. At the individual level, hoivever, this statistical relationship is meaningless. Also, they concluded, a clear-cut smoker's personality has yet to be found. Much research has been aimed at modifying this physiological habit by substituting lobeline, a drug which produces the effects of nicotine, for nicotine (British Tuberculosis Association, 1963; Goodman and Oilman, 1960). The inconclusive results of lobeline studies indicate the probability that there is a more compelling component in smoking than mere physiological addiction, if in fact there is any such addiction involved. Cigaret smoking has also been the subject of a number of behavior therapy studies. Several have focused attention

PAGE 28

22 on a comparison of the relative effectiveness of divergent treatment forms, and at least two of these have included an aversive conditioning procedure as one of the treatment methods. Koenig and Masters (1965), using seven therapists and 42 S^s betv;een the ages of 19 and 23, compared the effectiveness of systematic desensitization, supportive counseling, and aversive conditioning methods. The aversive conditioning procedure consisted of short-duration shock administered to the S_' s fingers as he proceeded to smoke two cigarets during the treatment session. All S_s received nine treatment sessions over a five-week span. While no significant treatment or interactional differences v.'ere found at the end of this period, significant therapist differences (p < .05) were delineated. The groups showed a significant decrease in smoking consumption from pre-treatment levels (52 per cent reduction; p < .001); six months later, the mean per cent reduction score had dropped to 19 per cent. Ober (1967) compared the results of a "self-control" group, an aversive conditioning group, one which received treatment based on transactional analysis concepts and methods, and a no-treatment control group. The S^s in the aversive conditioning group were instructed to self -administer shocks with a portable battery-operated shocker whenever they experienced the desire for a cigaret. Sixty Ss (college students) and two therapists were used. The S^s were seen for ten 50-minute group sessions over a four-week period. At termination of treatm.ent

PAGE 29

23 and after a one-month follow-up, all treatment conditions were significantly lower than the no-treatment control group (p < .001) Presumably, the cigaret consumption reduction rates for the experimental groups were also significantly lower than their pretreatment rates after treatment, although this is not explicitly stated, Followring treatment, the per cent reduction rates were 81, 100, and 52 per cent for the self-control, aversive, and transactional groups, respectively. One month later, these rates were 49, 58, and 57 per cent, respectively. The no-treatment control group showed a 3 per cent reduction in smoking following treatm.ent. No significant treatment, therapist, or interactional differences were found, however. Pyke et al . (1966) compared the results of one group receiving desensitization training, combined with regular group discussions on the ills of smoking, the viewing of films, and the reading of anti-smoking literature, with two control groups whose members merely kept frequency counts of their smoking consumption. The first control group S^s monitored their smoking for eight successive weeks, and the second kept frequency counts only during the first and eighth weeks. The experimental group Ss attended one group meeting and one private session each week for ten successive weeks. Fifty-five paid Ss , all college students, participated in the study, and a stated "desire to stop smoking" was the only selection criterion used. Apparently many, if not most, of the S^s smoked less than 20 cigarets per day prior to their participation. The results after eight weeks clearly favored the experimental group over

PAGE 30

24 the two control groups (p < .01), although little else can be definitely said with respect to the treatment procedures because of the potpourri of methods used. The follow-up data offered for the experimental group, while indicating some lasting effects of treatment over several weeks, were of questionable value as one third of the Ss in this group were not included. No follow-up data for the control groups v/ere presented. Other aversive stimuli have been used in an effort to decondition cigaret smoking. Wilde (1964) and Franks et al . (1966) used a mixture of smoke and hot air as the noxious UCS , and cessation of this gaseous mixture was made contingent on the escape response of snuffing out the cigaret. In the first case, Wilde treated seven Ss , between the ages of 25 and 54, all of whom smoked at least 20 cigarets daily. Three stopped smoking completely after two treatment sessions in tivo days. One was down to two cigarets per day after a single session, and another S^ changed over to a pipe after 20 sessions. Tivo others discontinued treatment and no mention was made of their progress, if any, or the number of treatment sessions received. No follow-up information was offered for any of the S s . Franks et al . began treatment with 23 adult S^s but only nine completed the prescribed course -12 conditioning sessions within a four-week period. Of these nine, follow^-up one-half year later revealed that four were not smoking, one was smoking "less", two were smoking as much as

PAGE 31

25 ever, and one had switched to a pipe. The ninth S was not heard from. The authors did not include the smoking rates for amy of the Ss immediately following treatment termination. And, finally, Greene (1964) attempted to reduce the smoking rate of mental retardates in a free-operant situation with the use of white noise, superimposed upon continuous music, as the negative reinforcement. A control group without the superimposed white noise was also run. Twenty-one S^s, ranging in age from 16.5 to 25.6 and with a mean I.Q. of 67.5, were used, and each participated in five consecutive daily sessions. The results showed that increased smoking rates were obtained over pretreatment levels for both the experimental and control groups (p = .10, p <.05, respectively), and these findings were attributed to the positive reinforcing properties of barely audible clicking noises made by the relays. A second control group was then run without the clicking noises, and no change in smoking rates was found. While the treatment procedures and methods of these studies concerned with the suppression of cigaret smoking are interesting and even innovative, they, like the studies reviewed earlier, offer little additional evidence bearing on the issues of this study. With this in mind then, a statement of the hypotheses investigated in this study is now in order. The Hypotheses Under Investigation Most of the clinical studies and case reports reviewed in this chapter have employed aversive conditioning treatment procedures based on a simple punishment model. That is, in

PAGE 32

26 attempting to obtain the suppression of unwanted behavior, a short-duration aversive stimulus has either been paired with the appropriate CSs, and/or both the target responses themselves. The prediction was made however (see pages 4_ 7), that increased and longer lasting behavior suppression would occur if patients were, in addition, positively reinforced for the performance of more desirable alternative instrumental acts incompatible with the behavior being punished. One way to accomplish this end in the clinical situation would be to utilize an aversive conditioning procedure based upon the experimentally familiar "escape" paradigm. Here, the conditions governing the onset of the aversive stimulus would be identical with those for a "simple punishment" procedure; stimulus termination, however, would be made contingent upon the performance of the appropriate escape response, thereby serving to positively reinforce such instrumental acts. A small number of the studies and clinical case reports reviewed earlier (Blake, 1965; Feldman and MacCulloch, 1965; MacCulloch et al , 1966) have attempted to utilize, with varying degrees of success, treatment procedures based upon such an escape paradigm. A perusal of the clinical aversive conditioning literature indicates, however, that a controlled comparison of treatment procedures based upon the two punishment models has yet to be attempted. The first two hypotheses of this study, then, are concerned with this issue; whether, in fact, a clinical aversive conditioning procedure based upon an

PAGE 33

27 escape model will result in significantly greater or more effective response suppression than one based upon the "simple" punishment model. Hypothesis 1 (HI) -Ss presented with an ordered set of stimulus items associated with, and related to cigaret smoking, and subjected to short-duration electric shock contiguous with the CS(s) or contingent upon the performance of the target response(s), will evidence a statistically significant reduction from pretreatment levels in their mean cigaret consumption rate on the last experimental treatment sessionday, as well as during the 12-week follow-up period. Hypothesis 2 (H2) -(1) Ss presented with the same ordered set of stimulus items and shock onset conditions as the HI Ss above, but in addition subjected to electric shock which terminates only upon the performance of an appropriate escape response pre-determined by E, will also evidence a statistically significant reduction from pretreatment levels in their mean cigaret consumption rate on the last experimental treatment session-day, as well as during the 12-week follow-up period. (2) In addition it is predicted that this mean reduction in cigaret smoking will be significantly greater than that for the HI Ss for the following: (a)' during the course of the experimental treatment period; (b) specifically on the last experimental treatment session-day; and (c) during the 12-week follow-up period. While the above hypotheses would appear to cover the central issue underlying the conception of this study, one

PAGE 34

28 further related consideration remains. As mentioned earlier, the experimental learning and conditioning literature has strongly indicated that, all other factors held constant, reinforcement delivered in a purely random or "chance" fashion has little lasting suppressive or facilitative effect on subsequent performance. All the clinical attempts utilizing aversive conditioning methods have at least assumed this much in the design of the treatment procedures. Nevertheless, as this experimentally derived finding has not been tested under clinical treatment conditions using an aversive stimulus, such as electric shock, it would seem appropriate, and even germane, to do so here. The results of Ss run under random shock conditions would offer a "base for comparison," putting the data obtained under the two experimental treatment procedures described above into a more meaningful perspective. Therefore, the following hypothesis has been incorporated into this study. Hypothesis 3 ( H3 ) -Ss presented with the same ordered set of stimulus items as those under HI and H2 , but subjected to randomly administered electric shock of short duration, will not evidence a statistically significant reduction from pre-treatment levels, either on the last experimental treatment session-day, or during the follow-up period. Hypotheses HI, H2 , and H3 , then, constitute the major hypotheses of this study. Addendum After the data collection phase of the study had

PAGE 35

29 gotten under way, certain observations concerning the reactions of the Ss to the daily shock session regime became apparent. Several Ss , after completing approximately half of the experimental treatment sessions, attempted to "buy" their way out of, or otherwise attenuate their commitment to complete the sessions yet remaining. These S^s , in essence, offered to more quickly terminate or reduce their cigaret consumption if E in turn would agree to eliminate some or all of the experimental treatment sessions remaining to be run. This matter will be expanded upon in the Discussion chapter. Accordingly, a fourth experimental group was then run to test the hunches generated by these observations, and the following hypothesis was included in the study. Hypothesis 4 (H4) -(1) S^s presented with the same experimental conditions as those under H2 , but with the added provision that they can avoid completely the aversive conditioning treatment session on any day within the treatment period imm.ediately following a day free of cigaret smoking, will also evidence a statistically significant reduction from pre-treatment levels in their mean cigaret consumption rate on the last experimental treatment session-day, as well as during the 12-week follow-up period. (2) In addition it is predicted that this mean reduction in cigaret smoking will be significantly greater than that for each of the other three groups for the following: (a) during the course of the experimental treatment period; (b) specifically on the last experimental treatment sessionday; and (c) during the 12-week follow-up period. All references to significance in the above four hypotheses refer to the .05 level of significance.

PAGE 36

CHAPTER II METHOD Subjects Twenty men and 12 women, all volunteers who wished to stop smoki.ng, served as S^s for this study. Most of these participants were either "middle level" professional staff members or nonprofessional personnel of the Edward Hines Jr. V. A. Hospital, nines, Illinois. Exajnples of the former were occupational therapists, corrective therapists, and medical technologists; and of the latter, secretaries and ward assistants. In addition, a small number of S^s (five) were recruited through a small classified advertisement placed in the local neighborhood newspapers calling for volunteers for a V.A. hospital-sponsored study, who wished to give up cigaret smoking. Hospital personnel were obtained through the use of bulletin board notices, personal contact, or referrals by other staff members familiar with the investigation. Prospective S^s were assessed for suitability in a preliminary interviei\: and then randomly assigned, as they became available, to one of the treatment groups. These groups were labeled the HI, H2 , and H3 groups, corresponding to the three major hypotheses, respectively. Group 4 was labeled and filled in like manner when it became operational midway in the data collection phase. Each group consisted of eight S^s ; groups 30

PAGE 37

31 HI, H3, and H4 received three female S^s each, while group H2 received two. Those interested in participating were selected as Ss if they were between the ages of 25 and 49, smoked an average of at least one but not more than two and a half packs of cigarets daily, and had been continuous smokers for at least the past four years prior to their participation in the study. In addition, all S^s had to voluntarily desire to stop smoking and be willing to cooperate with all the study's requirements. Those who indicated that they had been able to stop smoking on their own for periods longer than two weeks in the past were eliminated from further consideration. Analysis of variance on data of age, number of cigarets smoked per day, and total number of years smoked prior to participation in the study revealed no significant differences between the four groups at the .01 level of significance (Tables 9,10, and 11; Appendix A). Apparatus Electric Shock Source A matched impedance shock generator was specially constructed for use in this study. The circuit consisted of a variable transformer with 115 v AC input and 0-120v output which was connected to a 1,000 v CT step-up transformer. The output of the latter was then connected through a 100 k, 100 w power resistor, a 0-10 railliammeter , and two 1/100 amp. fuses to S. The intensity of the shock output to S was varied by setting the dial on the variable transformer, and the

PAGE 38

32 milliammeter allowed monitoring of the actual shock intensity delivejred. While the resistance of S^, and therefore the impedance of Sj could be matched directly by varying the value of the power resistor, this was not done, as it xvas not deemed necessary. This circuit made use of such safety features as an isolation transformer vjhich physically separated S from the wall current, thereby preventing the occurrence of dangerously intense shocks and burns, and a circuit fused on both sides of So This latter restricted the variability of shock said eliminated large surges of current from the circuit. In addition, the chassis ivas grounded. The S was connected to the shock circuit via Nu-way snap leads, which were in turn fastened to snaps embedded in rubber finger protectors. These latter were trimmed to provide a band approximately 3/4" wide, which slipped over the finger like a ring. Both electrodes were placed on the fingers of one hand, the index and third; thus, no current passed across S's body. A light coating of Sanborn Redux electrode Jelly was first applied to the fingers. Additional features of the unit consisted of a toggle on-off circuit switch and indicator light, an electric counter, and a remote switch for administering the shocks. Time r The device employed was an interval timer with automatic reset mads by Industrial Timer Corporation (Model P-4R). T\vo plug receptacles, one for a remote switch and the second

PAGE 39

33 for a standard AC load, were provided. Load-switch contacts were rated at 15 amps., the time cycle was 0-15 seconds, and the dial divisions were in quarters of a second. Random Interval Programmer The device used was a Gerbrands programmer, incorporating a Telechron synchronous motor (type B3, 110/120 v, 60CY) set at one RPM, and a standard raicroswitch. A loop of 16 mm leader film, taking 30 minutes for one complete revolution and randomly punched 40 times, was used to trip the microswitch. The punch-hole diameter allowed the shock circuit to remain open for one second with each successive activation. Experimental Room All preliminary interviews and experimental conditioning sessions were conducted in an easily accessible private office reserved for this purpose. The apparatus was arranged so that S, sitting on the opposite side of a desk from E, was unable to see the manipulation of the stimulus cards, remote control switch, or shock generator dial settings. While the shock generator sat on a low, small table at the right of E, no attempt was made to conceal its presence. The random interval programmer was mounted on a board attached to the far edge of the table in such a way that neither S nor E could determine beforehand when the next shock would occur. In addition to the above-mentioned apparatus, such items as chewing gum, life savers, peanuts, dietetic candies, ash trays, and matches were provided in the experimental room.

PAGE 40

34 Procedures In order to maLximize conditioning and enhance the resistance to extinction equally across all groups, certain variables mentioned in the literature as being relevant to punishment training were incorporated into all the treatment procedures. Thus: initial shock intensities for every session were introduced at levels perceived by the individual S^s as being distinctly unpleasant (Miller, 1960): novel stimulus items were introduced from time to time in accordance with a pre-determined schedule (McNajnara and VJike, 1958) and, shock intensities were varied randomly during each session from levels perceived as just unpleasant to levels which bordered on being painful (Church, 1963; Solomon, 1964). Preliminary Interview Prospective S_s for all groups were individually seen by E in a preliminary interview. If all selection criteria were met, a brief smoking history was then obtained, and the requirements for further participation were explained. These latter included agreeing to: (1) come in for daily sessions over the three-week experimental period for a total of 15 sessions , (2) keep a daily count of cigarets consumed through completion of the experimental sessions; and (3) be available for follov\;-up purposes over a three-month period. S^s were then asked to continue their usual smoking practices until their first experimental session, and also to begin keeping daily cigaret consum.ption frequency scores. Small cards the size of a cigaret package were provided by E for this purpose. Ss v\'ere cautioned not to rely on memory for

PAGE 41

35 the daily totals but to mark the cards each time a cigaret was lit, regardless of the number of puffs taken. _Ss were asked to bring in these daily tallies along with two or three packages of their favorite bran^ of cigarets for deposit, when they returned for the first experimental session. This latter request v/as made so that the act of purchasing cigarets would not be tacitly encouraged once the sessions began. The mean of the daily cigaret consumption frequency scores for the period betiveen the preliminary interview and the first experimental session provided each _S ' s cigaret consumption base rate. This period varied from five days to a week and always included three weekdays and a weekend. Also at this time a brief explanation of smoking behavior in simple learning theory terms was offered by E. Smoking was conceptualized as learned behavior which had become a highly practiced habit in a variety of life situations. S^s were told that the purpose of the experimental treatment sessions was to provide an opportunity for "unlearning" this behavior through the application of learning principles; specifically, by associating an unpleasant stimulus -shock -with that behavior which had come to acquire rewarding properties. The experimental nature of the study was mentioned, and E offered himself as an "advanced graduate student in clinical psychology" who was conducting research on methods which would help people give up the cigaret smoking habit. Before concluding the preliminary interview, several demonstration shocks were given in order to allay Ss ' anxieties

PAGE 42

36 about getting shocked, and to establish initial thresholds for uncomf ortableness and pain. An appointment for the first experimental session was then arranged. Approximately 35 individuals were disqualified from further participation during this interview for one of several reasons. A few smoked less than one pack of cigarets daily or had not been smoking long enough. About 20 others were unable to attend sessions on a daily basis. The remainder either did not wish to subject themselves to electric shock, or had second thoughts about giving up cigarets. Stimulus Items The stimulus items consisted of com.ponents of the smoking behavioral chain, ideational stimuli, and various "precipitating stimuli" such as, e.g., the smell of cigaret smoke, the sight of someone lighting up, and seeing a magazine advertisement for cigarets. Table 1 lists the stimulus items used, but not necessarily in the order presented. As indicated, many of the items were presented during every session, while others were introduced at pre-determined points after the sessions began. Also, while all S^s received the same number of items for each session, the content of several -primarily the ideational item.s -sometimes varied in accordance v:ith the idiosyncrasies of the individual S ' s smoking behavior pattern. Thus, when asked to imagine, e.g., the occasion for taking the first cigaret of the day, one S_ m.ight "see" himself reaching for his pack immediately upon awakening, while another might visualize taking his first cigaret of the day after breakfast.

PAGE 43

37 1

PAGE 44

38 Ifl

PAGE 45

39

PAGE 46

40 Item presentation was random. Each was written on an index card, and the cards were shuffled before each session. On occasion, changes were made by E as the individual cards came up to provide for a more logical ordering of the items. Experimental Shock Sessions The format followed during the sessions was essentially the same for all groups. Upon entering the experimental room, Ss pulled the two electrode-embedded rubber bands on the index and third fingers of their smoking hand so that the metal snaps were positioned against the palm side of the fingers. The bands were placed far enough back on the fingers so that normal finger dexterity was not unduly hampered. The previous day's cigaret consumption tally was then recorded by E. Stimulus item presentation began after a quick check by E determined that the electrodes were positioned correctly and the apparatus' was connected properly. For all groups, the sessions terminated when the electric counter on the shock generator indicated that the S^ had received 40 shocks. The sessions lasted, on the average, about 30 minutes, and, with the exception of the H4 group Ss, all Ss received a total of 600 shocks over the 15 sessions. The H4 group Ss averaged 350 shocks over this period. At the start of the first session, each S was advised that no specific restrictions would be placed on his smoking behavior during the duration of the study. It was suggested at that time, however, that if he attempted to "do something else instead" in response to the urge to smoke, progress

PAGE 47

41 towards the goal of terminating smoking would possibly be aided. Several alternative responses were then suggested as possibilities. Examples of these were the following: talcing a deep breath and holding it for 20 or 30 seconds, chewing or eating some gum or candy, taking a fev/ sips of cold water, performing an isometric exercise, or reviewing one's own reasons for wanting to stop smoking. It was then suggested that each S^ experiment with such alternatives until he found those which best suited him. This approach was decided upon for several reasons. It soon became apparent in working with several pilot ^s , and in general conversations with smokers, that many, if not most smokers had at one time read or heard about various ploys one could utilize to stop smoking. Many had tried one or more of these methods themselves. And too, some Ss wondered whether they should "fight" the effects of the experimental procedures, or do anything to help on their own. Telling Ss they could try to reduce their cigaret consumption away from the sessions, as well as suggesting some things that they could do, helped to standardize S^ attitudes and motivation, and also introduced a measure of experimental control. HI Grou p -S^s in this group received electric shocks of one second duration, administered at the points indicated in column 2 of Table 1, Shock onset was controlled by means of a remote control hand switch held belov; desk level; the shock stimulus v;as terminated by the circuit's automatic reset timer. No special instructions were additionally given to the HI group Ss.

PAGE 48

42 H2 Group -While the Ss in this group received shocks of variable duration, the shock onset points were identical to those for Ss in the HI group above. Before each H2 group S^ entered the experimental room, the automatic reset timer was disengaged from the circuit, thus enabling E to control both shock onset as xvell as shock termination. H2 group S_s were also given the following special instructions at the beginning of the first experimental session in addition to the general instructions noted previously: Once the shock begins, it will not turn off until you proceed to do something or say something, either as an alternative to what you will be doing upon my request, or in response to a question I might ask you. Your task, then, will be to respond in such a way that the shock will be turned off. Remember, you yourself will be able to turn off the shock every time by responding correctly in each situation. Let's take an example. The S was then asked to "light up", and shock onset occurred as he put the cigaret in his mouth, but before he lit it. "Correct" responses here included removing the cigaret and laying it down o_n the table, breaking the cigaret, putting it back in the pack, or throwing it in the waste basket. If the S_ did not immediately dispose of the cigaret, or if he removed it from his mouth but continued to hold it in his hand, E then said, "Remember now, you can terminate this shock. What can you do ivith that cigaret in order to turn the shock off?" In all instances, this was sufficient to prompt the S to get rid of the cigaret. Item presentation then proceeded in regular fashion. There were several "correct" responses, then, which the S could offer for most of the items. The third column of

PAGE 49

43 Table 2 lists examples of escape responses wh5.ch were defined as acceptable. To deter stereotypic or repetitious responding to any given item as it came up through the 15-session sequence, and to encourage the development of an array of incompatibletosmoking response tendencies, the same escape response was not always allowed to be the correct one. Often, when a £ would respond in a manner which had previously proved to be "correct," the shock would, nevertheless, continue, and E would say, e.g., "Yes, but what else could you do in this case?'' H3 Group -The £s of this group received electric shocks of one second duration, administered at random intervals. Tfie shock generator was plugged into the random programmer before the S entered the experimental room, and immediately after the electrodes were positioned, the circuit was activated. Thus, E neither controlled shock onset nor shock termination. No special instructions were additionally given to the ^s in this group. It \vas often necessary, however, for E to terminate the S's performance at the point at which Ss in the other three groujjs were getting shocked, in order to maintain stimulus item equivalency for this group. For example, if the stimulus item card called for shock onset to occur as the S placed the cigaret in his mouth, the H3 group S was told at this point to dispose of the cigaret and place the cigaret package back on the table. H4 Group -The procedures for Ss in this group were identical to those already described for the H2 group Ss, with the following exception: At the end of the first experimental shock session, each S ivas told that any given subsequent session

PAGE 50

44 could be avoided if, on the immediately preceding day, he completely refrained from smoking any cigarets . (The two weekend days were counted as one day.) Each S^ did, however, have to "report in" by phone or in person each weekday morning in order to apprise E of his smoking performance during the preceding day. It was pointed out to each S^ that, in effect, he could determine the number of sessions he would have to attend during the three-week experimental period. Follovr-Up Cigaret consumption follow-up data were collected for all S^s two, six, and 12 v\reeks after treatment termination. Ss were contacted two days prior to these dates and asked to keep tallies over a three-day period. Three-day means were then computed for the follow-up cigaret consumption scores. At the end of the 12-week follow-up period, each S was asked to informally express any impressions or thoughts he had about the study or his participation in it. These will be explored in the Discussion chapter.

PAGE 51

CHAPTER III RESULTS The dependent measure of this study consisted of the per cent reduction scores computed for each _S during both the experimental treatment and follow-up periods. These scores were based upon the mean of each S^' s pretreatment cigaret consumption tallies, obtained between the preliminary interviev/ and the first experimental session-day. Each individual's pretreatment mean was given a value of zero, and any subsequent reduction in smoking was converted from this base line measure into a per cent reduction score (or, in another sense, a per cent improvement score). For example, if a S ' s pretreatment mean consumption rate had been 40 cigarets per day, and he then smoked 30 cigarets during the second session-day, his per cent reduction score for that day vjould have been 25 per cent (30 divided by 40 = .75; .75 subtracted from 1.00 multiplied by 100 = 25 per cent). A per cent reduction score of 100 then, would indicate that the S^ did not smoke any cigarets on that particular day. Individual per cent reduction scores were computed from the number of cigarets each ^ smoked on each of the 15 session-days, and from the mean number of cigarets smoked during the three-day intervals two, six, and 12 v>'eeks after treatment termination. These individual per cent reduction scores are shown in Appendix B. A total of 11 45

PAGE 52

46 S_s , eight during the first week and three during the second, were dropped from participation after treatment began. Five of these decided they no longer wanted to stop smoking, and the other six either couldn't make the treatment sessions on a daily basis or failed to show up for their scheduled appointments. The partial records of these 11 S_s were not included in the data analysis nor are they shown in Appendix B. Figure 1 shows the MPSR scores of the four groups plotted across both the experimental treatment and follow-up periods. As hypothesized, the K4 group MPSR scores are consistently larger than those for the other three groups across the sessiondays, but the relative rankings of the other three group curves are less pronounced. The 15th session-day MPSR scores of 97, 91, 89, and 86 for the H4 , H2 , HI, and H3 groups, respectively, are ranked in accordance with the group ordering predicted by the hypotheses. Two, six, and 12 weeks after treatm.ent termination, however, the relative group rankings can again be seen to be ordered somewhat differently, with the largest MPSR scores consistently being attained by the H2 group. Perhaps the most notable feature of Figure 1, hov;ever, is not the relative orderings of the group MPSR scores at specific points on the horizontal sixis, but rather the high degree of concordance of the curve slopes across both the session-days and the follow-up periods. This concordance suggests that the differential effects of the experimental procedures on the mean smoking reduction rates of the groups v/ere not

PAGE 53

o

PAGE 54

48 great throughout either the experimental treatraent or followup phase of the study. Analysis of the data does, in fact, bear this out. Table 2 shows the results of a repeated measurements analj/sis of variance of the HI, H2,ajid H3 group MPSR scores compiled during the experimental treatment period. The H4 group was excluded from this primary analysis, as the Ss in this group differed from those in the other three in the number of shock sessions they received. (The mean number of shock sessions administered the H4 ^s was 8.5; the least number of sessions a H4 group S^ received was five, and the most, 12.) TABLE 2 REPEATED MEASUREMENTS ANALYSIS OF VARIANCE OF THE MPSR SCORES ACROSS SESSION-DAYS-GROUPS HI, H2, AND H3 N = 24 Sources of Variation df Mean Squares F P Between Ss

PAGE 55

49 From the results of this analysis of variance, it is evident that neither the differential effects of the various group procedures, nor the procedures by session-days interactibn were significant sources of variance. Ihe main sessiondays effect--i.e. , the effect of treatment repetition over time-was, however, highly significant (F = 50.40; P<.005). Part (2)a of Hypothesis 2, then, was not supported. The HI, H2, and H3 group MPSR scores across sessiondays were then combined, and a Neuman-Keuls test of all the ordered pairs of session-day means was computed. The results, shown in Table 3, corroborate what the group curves suggest in Figure 1; namely, that most of the smoking reduction occurred during the first half of the experimental treatment period. As Table 3 indicates, no further increase in per cent smoking reduction, from the eighth session-day to any of the remaining seven session-days, attained statistical significance at the .05 level of confidence. In order to determine what effect the inclusion of the H4 group MPSR scores would have on the Group Procedures F ratio, a second ancillary repeated measurements analysis of variance was computed. Despite the slight divergence of the H4 group curve seen in Figure 1, the results of this second analysis, shown in Table 4, parallel those obtained in the first analysis. It is interesting to note that the Group Procedures mean square is, relatively speaking, much larger than the corresponding one

PAGE 56

50 Q O H to I/) o CO K 8 a c z • Q) U 0^ o in >N O (tJ H o a> 00 * * 00 O

PAGE 57

51 obtai^ned in the first analysis. Nevertheless, only the SessionDays main effect v/as, again, a statistically significant source of variance (F = 56.85; P<.005). These results, then, failed to confirm both Part {2)a of Hypothesis 2 as well as Part (a) of Hypothesis 4. TABLE 4 REPEATED MEASUREMENTS ANALYSIS OF VARIANCE OF THE MPSR SCORES ACROSS SESSIONDAYS-GROUPS HI, H2, H3, AND H4 N = 32 Source of Variation df Mean Squares F P Between Ss 1 . 38 Group Procedures

PAGE 58

52 then, for the effects of shock, per se, on cigaret consumption on this last experimental treatment day, only the MPSR scores of the first three groups were included in the first, or primary, analysis of variancec The results, summarized in Table 5, reveal no significant differences between the MPSR scores of the three groups; therefore, they failed to support Part (2)b of Hypothesis 2. TABLE 5 ANALYSIS OF VARIANCE OF THE MPSR SCORES ON THE 15th SESSION-DAY-GROUPS HI, H2, AND H3 N = 24 Source of Variation df Mean Squares F P Procedures Between 2 47.79 < 1.00 Groups Procedures Within 21 256.58 Groups A second analysis of variance, this time including the H4 group MPSR scores on the 15th session-day, was additionally calculated. The results, shown in Table 6, also indicate no significant differences between the group MPSR scores, although again, this second Group Procedures mean square is larger than that obtained in the first analysis. The results again did not support part (2)b of Hypothesis 2, as well as Part (b) of Hypothesis 4.

PAGE 59

53 TABLE 6 ANALYSIS OF VARIANCE OF THE MPSR SCORES ON THE 15th SESSION-DAY--GROUPS HI, H2 , H3, and H4 N = 32 Source of Variation df Mean Squares Procedures Between 3 169.37 < 1.00 Groups Procedures Within 28 205.97 Groups With respect to the data compiled during the follow-up period, a final repeated measurements analysis of variance of the MPSR scores of all four groups computed two, six, and 12 weeks after treatment termination was then calculated. As the independent variable -the passage of time -operated equally for all groups, the H4 group MPSR scores were included, and only one analysis was made. The results are summarized in Table 7. Again, the differential effects of the experimental procedures , this time on the recovery rates of the groups , were not statistically significant at the .05 level of confidence, nor, was there a statistically significant Procedures by Folloxv-Up interaction effect. The main effect of time (Follow-Up) was, ho;\rever, significant beyond the .005 level of confidence. These results, then, failed to support Part (2)c of Hypothesis 2 as well as Part (b) of Hypothesis 4.

PAGE 60

54 TABLE 7 REPEATED MEASUREMENTS ANALYSIS OF VARIANCE OF THE MPSR SCORES TWO, SIX, AND 12 IVEEKS AFTER TREATMENT TERMINATION --GROUPS HI, H2 , H3 , and H4 N = 32 Source of Variation df Mean Squares Between Ss

PAGE 61

55 TABLE 8 NEUMAN-KEULS TEST OF ALL ORDERED PAIRS OF F0LL0l^7-UP MEANS FOR GROUPS HI, H2 , H3 , AND H4 Ordered Means 40.0 52.8 78.6 Ordered Follow-Up Points 1 ( 12 ivks . ) 2(6 wks . ) 3(2 wks . ) Differences 1 12.9* 38.6* Between Mean Pairs 2 25.7* _____ To determine whether the mean cigaret consumption scores of the four groups w^ere significantly lower than their respective pre-treatment levels on the 15th session-day, and two, six, and 12 weeks after treatment termination, a single t-test (onetai-led) of the difference between the over-all pre-treatment and 12-week correlated means ivas computed (r = .24). The three-day interval means of each S^, compiled from the actual numbers of cigarets smoked by all 32 ^s on these two occasions, were the data used in the calculations. (See Appendix C). The "t" value obtained (5.29) was significant beyond the .0005 level of confidence. (Pre-treatment M = 34.3, S.D. = 6.96; 12-iv'eek M = 20.3, S.D. = 13.24.) The justification for using the over-all pre-treatment aind 12-week means to compute only one "t" follox^ed from the fact that the pre-treatment cigaret consumption scores , and the 15th session-day, and follow-up MPSR scores of the four groups

PAGE 62

56 did not differ significantly from each other (see Table 10, Appendix A; Tables 6 and 7). Thus, if the "t" value for the difference between the over-all pre-treatment and 12-week means was significantly large, then the differences betiveen the overall pre-treatment mean and the over-all 15th session-day, twoweekj and six-week cigaret consumption rate means would also have to be statistically significant; these latter over-all mean differences would have been even larger than the difference between the over-all pre-treatment and 12-week means. And, since the cigaret consumption rates of the four groups themselves did not differ significantly from each other at any point, then it could be said that the cigaret consumption rate of each group on the last day of treatment, and during follow-up, was significantly lower than its pre-treatment level. Thus, Hypothesis 1, Part (1) of Hypothesis 2, and Part (1) of Hypothesis 4 were supported. Hypothesis 3 was not. In summary, then, the prediction that the cigaret consumption rates of the four groups would differ significantly from each other in a prescribed fashion, as a function of the differential effects of the experimental procedures each croup received, was not supported in any way. This was true for both the experimental treatment and follow-up phases of the study. Irrespective of the nature of the aversive shock treatment received, the mean performance of each group was essentially the same as that of the other three. The prediction that the cigaret consumption rates of the HI, H2 , and H4 groups on the last day of treatment, and during follow-up

PAGE 63

57 would be significantly lower than their respective pre-treatment levels was supported; the prediction that the H3 group's cigaret consumption rates would not be significantly lower was not . * Additionally, it was observed that the Session-Days inaiin effect (the effect of treatment repetition over time) was the only significant source of variance contributing to the reduced cigaret consumption rates of the groups during the experimental treatment phase. Upon combining the MPSR scores of the HI, H2, and H3 groups, it ivas found that after the eighth session-day, no further decrease in smoking during the remaining seven session-days attained statistical significance, Finally, during the follow-up phase, smoking recovery, as evidenced by the increased smoking consumption rates of all four groups, appeared to be a negatively accelerating function of the passage of time. There were no other significant sources of variance.

PAGE 64

CHAPTER IV DISCUSSION The two major outcomes of this research were the following: (1) the failure of the results to demonstrate a significant Group Procedures main effect , both during the experimental treatment and follow-up phases; and (2) the finding that cigaret consumption rates of the groups , all varying together, were significantly lower than their pre-treatraent levels during both the experimental treatment and follow-up phases. Thus, the inherent differences imputed to the treatment procedures as a function of the conditioning models upon which they were based, were greatly attenuated in practice. Even so, the above findings demonstrate that treatment variables common to all four experimental treatment situations were operating to effect a significant smoking reduction for all four groups. This common over-all treatment effect was, in all probability, either the result of (1) confounding arising from the procedures themselves which served to make the procedural effects more similar than dissimilar, (2) the presence of uncontrolled situational variables, common to all the treatment conditions, which overshadowed or negated the differential effects of the individual treatment procedures , or (3) some combination of both (1) and (2). 58

PAGE 65

59 Confounding as a Function of the Procedures Reactive Inhibition IXiring each experimental treatment session of approximately 30 minutes' duration, 40 stimulus item presentations were made. The HI and H3 group Ss simply responded to each and were, at least in the case of the former Ss , then shocked for one second at the appropriate shock point. The situation was, however, more complicated for the H2 and H4 group Ss . Upon the presentation of each stimulus item, these S^s had to first begin the task of arriving at the "correct" escape response which would terminate the distinctly unpleasant shock. It was not uncommon for 20 or more seconds to elapse between shock onset and shock termination. The "activity level" during the H2 and H4 group treatment sessions, then, was far greater than that which obtained during typical HI and H3 group sessions. One consequence of this was a shortening of the interstimulus item intervals for the H2 and H4 groups, a situation somewhat analagous to "massed practice." Increased response effort, a result of this "massed practice" effect, as well as heightened tension as a consequence of far greater exposure to shock, led to the H2 and H4 group treatment sessions being far more intense and task-oriented. This state of affairs may well have resulted in a buildup of response inhibition during each session, a phenomenon experimentally known to adversely affect resistance to extinction (of, in this case, the newly acquired alternative responses to smoking) (Kimble, 1961).

PAGE 66

60 Thus, while in theory, the H2 and H4 group treatment procedures should have resulted in the systematic positive reinforcement of appropriate non-smoking escape responses, and, therefore, longer lasting smoking behavior suppression, the contaminating effects of reactive inhibition may have attenuated this expected result. Intermittent Reinforcement Probably the most surprising group performance was that of the random shock ( R3 ) group, a group for which it was predicted there would be no significant mean reduction in smoking, both during the experimental treatment and follow-up phases. Once again, it would appear that the number of stimulus item presentations during the 30-minute session, as well as the frequency of shock onset --for the H3 group, an average of one shock approximately every 45 seconds --were important factors in determining the results obtained by this group. With the occurrence of 40 stimulus item presentations, it was inevitable that many of the shocks were delivered at points in the temporal order which were appropriate for conditioning; i.e., shock onset was often contiguous with some aspect of a S^' s ongoing performance of a motoric or ideational smoking response. At other times, the shock would be delivered after the "optimal" point in the temporal order had passed. Thus, in effect, the H3 group was in many ways as much a partial reinforcement group as it was a random shock group. As there is experimental evidence indicating that intermittent negative reinforcement of an operant acquired under essentially positive reinforcement contingencies not only leads to behavior suppression, but also increased resistance to recovery of the suppressed response (Mowrer, 1960), this may explain in part the performance of this group, particularly

PAGE 67

61 during follow-up. The issue is less clear with respect to the possible effects of delay of (negative) reinforcement, but there is some evidence to indicate that this phenomenon, especially if the delay is variable, increases resistance to recovery over that obtained by immediate punishment alone (Crum, et__a_l . , mentioned by Feldman and MacCulloch, 1965). While it is not possible to determine to what extent the effects of intermittent reinforcement, as well as delay of reinforcement, adventitiously increased the mean smoking reduction rate of the H3 group, the possibility does exist that it may have been considerable. Respondent Conditioning It might also be argued, again with the mean smoking performance of the H3 group primarily in mind, that the internal response states of the Ss came to acquire suppressive properties during the experimental treatment sessions as a function of their contiguity with electric shock onset. These internal respondents, then, elicited in subsequent situations conducive to smoking--or to put it in slightly different terms, in the presence of those CSs which typically would have precipitated smoking behavior--may have served to attenuate a given S^' s desire to smoke. If such respondent conditioning did in fact occur to a significant degree, this might help explain why the mean smoking reduction rate of the H3 group n particular, but also for the HI group, was not significantly different from the mean smoking rates of the other two groups, especially during the follow-up phase.

PAGE 68

62 It is possible, then, that the variables mentioned in this section, either singularly or in combination, may have caused the net effects of the treatment procedures on the S^s to be more alike than dissimilar. Such confounding, as a function of the treatment procedures themselves, might explain, at least in part, the absence of significant results obtained in this research. In the next section, several possible contajninating factors, arising from over-all experimental conditions common to all the groups, will be looked at. Situational Variables as a Source of Confounding Interpersonal Effects Many behavior therapists have increasingly focused their attention on the issue of the importance of the therapistpatient relationship as a catalyst for behavior change. For exEunple, Barker (1965) talks about the "personal attraction" which may develop towards the therapist, and which "can't be ignored'." Andrews (1966) maintains that behavior therapists, in common with traditionally oriented therapists, are supportive, authoritarian, directive, encouraging, etc, in response to the needs of their individual patients, and that the establishment of satisfactory relationships is mandatory if behavior change is to occur. Feldman and MacCulloch (1965) admitted that their patients "liked to talk" and that they often gave them advice and reassurance. These authors claim that such practices are necessary in order to gain good "background rapport." Coates (1964), and Meyer and Gelder (1963) assert that in all of the conditioning procedures employed to date in

PAGE 69

63 the clinical literature, the therapist-patient relationship has played a major, if not always recognized, part. And Oswald (1962) has claimed that the success of aversive conditioning, in particular, is vitally dependent upon therapist-patient relationships. It is perhaps impossible to determine what part relationship variables played in influencing and determining the results of the present study. Koenig and Masters (1965) used seven therapists to treat 42 smokers and found a significant therapist difference (p < . 05 ) , but not significant treatment or interactional differences. Thus, the therapist to whom the smoker was randomly assigned, and not the treatment method, was the significant determinant of success with respect to smoking reduction. However, Ober (1967), using three therapists, found no significant treatment, interaction, or therapist effects in his study of smoking behavior. He attributed this lack of a significant therapist main effect to the "highly standardized" treatment procedures his therapists adhered to. Nevertheless, as the smoking reduction scores for the three treatment groups in his study were significantly lower than their pre-treatment levels upon treatment termination, the possibility still remains that relationship effects common to all groups were responsible for this over-all reduction to some significant degree. With respect to the present study, the attempt was made to minimize E • s influence on the mean smoking consumption rates of the experimental treatment groups. For example, not only

PAGE 70

64 were the treatment presentations standardized, incidental or unnecessary conversation was discouraged, and comments of an evaluative nature concerning the smoking performance of the Ss were withheld. Nevertheless, it may be naive to assume that such attempts alone can effectively control or significantly minimize the E influence on S_ performance . It was noticed, e.g., that many of the S^s still appeared to view the treatment session as an occasion for non-task verbal interaction. Such Ss frequently attempted to bring up conversational material of a more personal nature. Others either appeared to want some sort of confirmation that they were progressing satisfactorily, or encouragement from E that they would, in fact, be able to give up cigarets. On occasion, S^s would appear angry, implying by their comments that E was being "unfair" for continuing to shock them despite the fact that they were obviously doing well in their efforts to quit smoking. Exsimples of "resistance"--the breaking of appointments , arriving late, etc. --were sometimes manifest. Rosenthal (1966), in his recent book on experimenter effects, discusses an array of situational variables which have been shown to influence research outcome. Of particular relevance for the present study is the one he labels the "acquaintanceship" variable. Since many of the individuals who served as S_s either worked on the same or adjacent wards, or ate in the sajne lunchroom as E, the treatment sessions were not the only source of E-S_ contact. For these individuals, then, E was more than an anonymous person who "shocked them

PAGE 71

65 for smoking." He was also an acquaint2U-ice ajid co-worker. Under these circumstajices J it is possible that at least some Ss reduced or teiininated their cigaret consumption--especially during the treatment phase--either because they didn't want to "disappoint" someone they knew on an individual basis, or because they felt guilty or embarrassed about failing in such a person's presence. It is also interesting to speculate about the degree to which E ' s aversive properties were enhanced during the treatment phase of this research. Through repeated association with electric shock, and by virtue of being the person who, insofar as the perception of many of the Ss was concerned, was "trying to get people to stop smoking," E may have acquired significant aversive stimulus properties in his own right. In this vein, Rosenthal also points out the tendency for Ss to perceive, either correctly or erroneously, E as someone who "expects" them to respond in accordance with their perception of the goals of the experiment. And, as Rosenthal continues, Ss often do just that, primarily for this reason alone. Thus, E's very presence in the hospital setting may have affected the smoking consumption rates of many Ss beyond that which would have obtained from E^-S_ contact confined only to the treatment room. Three months after treatment termination, each S_ was informally asked to give any impressions he had about the treatment he had received. Perhaps indicative of the importance of the relationship effect was the observation offered by al-

PAGE 72

66 most every S^ that E^' s presence in the treatment situation was an c-vtremely important source of smoking behavior influence. Many S^s reported, in fact, that this influence continued after treatment termination. On the other hand, approximately 80 ; per cent of the S^s either denied or downgraded the importance of shock, per se, as being a major factor in their reduction or cessation of smoking. Perhaps an exeunple from Goldiamond's (1965) review of stuttering and fluency research is most apropos at this point. Goldiamond mentions one S^ who completely denied that the occurrence or non-occurrence of shock during the experimental period had anything to do with his non-fluency rates, even though the data clearly indicated that the S^'s verbal behavior had been under direct control of the reinforcement contingencies. Nevertheless, while it is perfectly plausable to suspect that the S^s in the present study were either unaware of, or felt the need to deny, the effect shock had on their smoking behavior, it is an interesting fact that the major focus of their comments was on the interpersonal aspects of the experimental situation. Subject Motivation In all likelihood, S motivation represents a variable complex whose effects on performance and treatment outcome are only incompletely understood and poorly controlled (Meyer and Crisp, 1966). A number of writers have discussed the importance of positive initial attitudes towards therapy and strong motivation to change, with respect to the ultimate outcome (e.g., Lazarus, 1963; Meyer and Gelder, 1963). The Ss used

PAGE 73

67 in this study all appeared, at least initially, to be well motivated. All were voluntary participants, professed the strong desire to give up smoking, and had one or more personally significant reasons underlying their desire to give up cigarets. Yet, motivation ivas often observed to fluctuate during the course of the study in ways which may have introduced important changes into the experimental situation. The most common S reaction observed by E after the sessions had gotten under way, was the emergence of ambivalence-"second thoughts" about giving up cigarets "at this time." Some S^s seemed dismayed that the task of giving up cigarets might require effort and hard work on their part; i.e., that there was no "magic" involved. Others seemed to realize, the closer they Ccune to the goal, the extent to which they had become dependent upon cigarets. At least five or six Ss expressed great concern about failing; i.e., not being able to quit after committing themselves to spouses, relatives, or friends. Perhaps the most interesting reaction noted was the tendency for many of the S^s across groups to become "unhappy" with the course of treatment, especially around the 7th, 8th, or 9th session. This was particularly pronounced if, by that time, a given S^' s cigaret consumption rate had declined sharply. Such S^s often attempted to negotiate new terms with E, the goal being to attenuate the original agreement to meet for the full sequence of 15 sessions on a daily basis. It was primarily for this reason that the H4 group was begun. It was felt that if Ss could control, in part, the ajnount of punishment they received, their motivation to terminate

PAGE 74

68 smoking more quickly would be strengthened. The reward value of avoiding a shock session on the day immediately following one free from smoking, it was further felt, would provide the S^s with sufficient incentive to continue abstaining from smoking on the day that the session was being avoided. It was hypothesized, then, that after such S^s had been able to avoid getting shocked for several days as a consequence of successfully abstaining from smoking, their ability to continue not smoking after treatment termination would be correspondingly greater than that evidenced by the HI, H2 , and H3 group Ss. As the H4 group mean cigaret consumption rate during this period was not significantly different from tliose of the other three groups, it is obvious that the above contention was not supported. Perhaps the punishment value of the shock sessions themselves may have been over-estimated. If so, then it might be logical to assume the following: that the amount of positive reinforcement obtained through shock session avoidance ivas not sufficient to establish inhibitory or selfcon trolling mechanisms powerful enough to overcome the urge to smoke, once the threat of punishment (attending shock sessions) was removed. On the other hand, it is also possible that the differential effects imputed to the H4 group procedure--and to the other group procedures as well--may have been viable and operating as hyj^othesizedo However, these experimental effects, though present, may have been overshadowed by more potent situational variables common to all the groups.

PAGE 75

69 In short, much of the smoking reduction or cessation evidenced by all groups during the experimental treatment phase of this study may have been induced by interpersonal or relationship considerations mefitioned in this section. It should be pointed out that even the H4 group Ss , who attended an average of only 8.6 shock sessions over the three-week experimental period, received daily E contact whether they successfully avoided a session or not. And, insofar as follow-up performance is concerned, motivational factors (i.e., ambivalence about really giving up cigarets , possible feelings of dependency and loss, etc.) may have accounted, at least in part, for the degree of smoking recovery evidenced by all the groups. In the next section, some considerations for future research bearing on the points mentioned in this chapter will be discussed. Some Issues for Future Research If the major questions posed by the findings of this study are to be resolved in a satisfactory manner, several issues will have to be considered and dealt with in subsequent investigations. Before proceeding, one point should be made clear. Even though the smoking reduction rates obtained in this study compare quite favorably with the results of other smoking investigations reviewed earlier in the Introduction chapter, the major concern of this research is not smoking reduction or cessation, per se. The major issues are (1) whether treatment procedures based upon an active escape

PAGE 76

70 conditioning model are any more effective in suppressing unwanted or maladaptive behavior than those based upon simple punishment models, and (2) what the effects of random negative reinforcement are on the performance rates of such behaviors. As this chapter's discussion clearly suggests, before the differential effects of various treatment procedures can be successfully compared, they must first be demonstrated in practice. Therefore, to the degree that it is possible, potential sources of confounding pointed out in the preceding pages must be controlled or removed from future experimental situations. Perhaps the first possible source of confounding that should be dealt with is the relationship variable complex. It is apparent from the present research that E^ effects on S^ performance must be minimized. A step towards this end would be to use Es who are not known to the S_s . Certainly Es should not be co-workers, or have contact with S^s beyond that which is actually necessary during the treatment sessions themselves. An even better solution might be the removal of E from the immediate stimulus environment while S^s are being run. Stimulus item presentations could be programmed through the use of tape recorders, projectors, or written instructions, and shock could be delivered remotely through the use of one-way mirrors or automatic devices. The use of "blind" E^s -those who do not know to which group a given S^ has been assigned -is also indicated. And, to the degree that E-S_ contact is necessary, multiple Es could be utilized for each S.

PAGE 77

The treatment procec3ures themselves should be tightened so that the contaminating effects of, e.g., reactive inhibition, partial reinforcement, or delay of reinforcement are not introduced. Towards this end, optimal interstimulus item intervals, as well as the optimal number of stimulus item presentations during each session, should be determined. With respect to the number of treatment sessions actually needed, it will be recalled that the results cited earlier indicated that further reduction in smoking for the HI, H2 , and H3 groups was not significant beyond the eighth session-day. Perhaps if fewer shock sessions, and/or a shorter experimental treatment period had been incorporated into the present research design, some of the resistance evidenced by many of the S^s would have been circumvented. Changes in the escape paradigm used in the present study might also be considered in subsequent investigations. Solomon (1964), among others, has pointed out that active escape procedures are most effective when they eventually lead to stable avoidance responding. For methodological considerations--primarily, to insure that all S^s received the same number of shock onsets during each treatment session--the H2 group S^s could only terminate the shocks, not avoid themo Perhaps the differential effects of the H2 group (escape) procedure would have been more pronounced, then, if active avoidance responding had been allov;ed to develop. Finally, the findings and observations of the present study point up the need for incorporation of a non-shock control

PAGE 78

72 group in future research attempts. The considerations of S^ availability and time precluded the inclusion of such a group here. Additionally, it was thought that the random shock group would serve the sajne function. The results obtained from a non-shock group would establish a more meaningful base from which to compare the results obtained from the groups utilizing shock. Most importantly, however, the results of such a group might be most illuminating insofar as the issue of the importance of relationship and motivational variables for behavior change is concerned.

PAGE 79

CHAPTliR V SUMMARY In the majority of the published clinical aversive conditioning studies, the treatment procedures have been based upon a simple punishment model. That is , a short-duration aversive stimulus (usually electric shock) has either been paired with appropriate CSs , and/or the target behaviors themselves. The experimental learning and conditioning literature, however, has indicated that increased and longer lasting behavior suppression would occur when procedures based upon an escape paradigm are used. In addition, experimental findings have also shown that aversive stimuli, randomly administered, have little, if any, lasting suppressive effects on specific ongoing behaviors. Since a comparison of the differential s.uppressive effects of procedures based upon simple punishment, escape, and random reinforcement paradigms has not been made to date under clinical conditions, this study attemped to do so. The target behavior used was cigaret smoking, and the aversive stimulus was electric shock. Thirty-two volunteers who wished to stop smoking served as S_s during the course of this investigation. All were between the ages of 25 and 49, smoked between one and two and a half packs of cigarets per day, 73

PAGE 80

74 and had been continuous smokers for at least four years prior to the5_r participation as _Ss. Initially, three experimental treatment groups based upon the above mentioned paradigms were begun. Eight S^s were randomly assigned to each as they became available. All Ss attended 15 individual treatment sessions on a daily basis (omitting weekends), and all received the same number of stimulus item presentations and shock onsets during each session., After the data collection phase had gotten under way, a fourth (session-avoidance) group, whose Ss could miss a scheduled shock session on any day immediately follov;ing a day free of smoking, was initiated. Both motoric and ideational type stimulus items related to smoking behJivior vjere used. The number of cigarets smoked during each of the treatment session-days was recorded for each ^o Individual cigaret consumption scores were also collected two, six, and 12 weeks after treatment termination. The hypotheses predicted that the significantly largest meajT smoking reduction rate during both the treatment and follow-up phases would be attained by the sessionavoidance group. This was to be followed, in decreasing order of procedural effectiveness, by mean smoking reduction rates of the esc£i.pe, simple punishment, and finally random shock groups. It was additionally predicted that the session-avoidance, escape, and simple punishment group mean consumption rates on the last session-day, and t\\.'o, six, and 12 weeks after treat-

PAGE 81

75 ment termination, would be significantly lower than their respective pre-treatment levels. The results clearly showed that , in contradiction to the hypotheses, the mean smoking reduction rates of the four groups did not differ significantly from each other during either the experimental treatment or follow-up periods. In other words, each group procedure was essentially as effective as any other in suppressing smoking behavior. Also, the mean smoking reduction scores of all the groups on the last sessionday, and two, six, and 12 weeks after treatment termination, were significantly lower than their pre-treatment levels. The over-all smoking recovery trend evidenced during the followup period was, however, pronounced. While evidence suggested that uncontrolled variables common to all four treatment groups were operating to effect an over-all reduction in smoking, differential effects of the treatment procedures themselves were not demonstrated. It was hypothesized that the possible confounding effects of reactive inhibition, intermittent reinforcement, and adventitious respondent conditioning, which may have been introduced by the procedures themselves, as well as relationship and motivational factors, combined to effect the obtained results.

PAGE 82

APPENDICES

PAGE 83

77 APPENDIX A TABLE 9 ANALYSIS OF VARIANCE OF AGE-GROUPS HI, H2 , H3, AND H4 N = 32 Source of Variation df Mean Squares F P Age, Bet^veen Groups 3 51.67 < 1.00 Age, Within Groups 28 76.71 TABLE 10 ANALYSIS OF VARIANCE OF THE PRETREATMENT MEAN NUMBER OF CIGARETS SMOKED PER DAY-GROUPS HI, H2 , H3, AND H4 N = 32 Source of Variation df Meam Squares F P Cigarets per Day, 3 17.67 < 1.00 Between Groups Cigarets per Day, 28 51.71 Within Groups TABLE 11 ANALYSIS OF VARIANCE OF THE NUMBER OF YEARS A CIGARET SMOKER-GROUPS HI, H2 , H3, AND H4 N = 32 Source of Variation df Mean Squares Years Smoked, Betvveen 3 7.67 < 1.00 Groups Years Smoked, Within 28 62.25 Groups

PAGE 84

78 (X

PAGE 85

(X p f^ O CM t^ H rH voorot^w^ino COO'^t^^DCXlrHiH 79 oo^vOvOMom OOt^CCt^vOOLTl vOOOOOO^OO O^OOOOt^OO noooocooo a^oooovooo ooon^^j'o^o OOOCr^^0t^C5^O OONOOCMOOD OOOiCOOoOOCO OO'^OONiOO Q OOOOOOooO OOOOOOCOO H r-( iH r-l H iH i-l o^ o vo o oo o o o coocoor-ooo ooooo^oo OOOOOC7 in t^ooc^ot^inin ^NooovOiHin vooiooomu-)^ t^OO-iOO-HO^O LOOCOOONfnCM ln\oooo\oo^u^ O^ ^' O N CM O C3^ 10 irit^coa>LnincMrH ^rHrHt^CMHOCM Xf CN] in O xf' iH iH rH CM CO ^ in vO t-~ cinoao ^H

PAGE 86

80 APPENDIX C . TABLE 13 THREEDAY MEANS FOR EACH S COMPILED FROM THE ACTUAL NUMBERS OF CIGARETS SMOKED BEFORE TREATMENT AND AT THE END OF FOLLOW-UP Before Treatment After Follow-Up 31 25 28 11 25 24 HI Group 35 30 45 31 30 24 42 O 24 10 23 6 40 36 42 H2 Group 26 25 38 48 20 31 28 28 30 32 11 30 24 42 40 H3 Group 34 O 28 10 44 20 26 25 38 37 28 7 38 35 25 H4 Group 30 8 43 41 34 30 41 40 40 34

PAGE 87

REFERENCES Andrews, J. D. Psychotherapy of phobias. Psychol. Bull . , 1966, 66^, 455-480. Azrin, N. H. Punishment and recovery during fixed-ratio performance. J. exp. Anal. Behav . , 1959, 2, 301-305. Azrin, N. H. Effects of punishment intensity during variableinterval reinforcement. J. exp. Anal. Behav ., 1960, 3, 123-142. Bancroft, J. H. , Jones, H. G. , and Pullan, B. R. A simple tr£insducer for measuring penile erection, with comments on its use in the treatment of sexual disorders. Behav. Res. Ther ., 1966, 4, 239-241. Bandura, A. Punishment revisited. J. consult. Psychol ., 1962, 26 , 298-301. Barker, J. C. Behavior therapy for transvestism: A comparison of pharmacological eind electric aversion techniques. Brit. J. Psychiat ., 1965, 111 , 268-276. Barker, J. C. , Thorpe, J. G. , Blackmore, C. B. , Lavin, N. I., and Conway, C. G. Behavior therapy in a case of transvestism. Lancet , 1961, 2^, 510. Blake, B. G. The application of behavior therapy to the treatment of alcoholism. Behav. Res. Ther ., 1965, 3_, 75-85. Blake, G. A follow-up of alcoholics treated by behavior therapy. Behav. Res. Ther ., 1967, 5, 89-94. Brady, J. V. Ulcers in "executive monkeys." Scient . Amer . , 1958, 199 , 95-103. British Tuberculosis Association, Smoking deterrent study. Brit, med. J . , 1963, 2, 460-487. Brov/n, J. S., Martin, R. C. , and Morrow, M. W. Self -punitive behavior in the rat: Facilitative effects of punishment on resistance to extinction. J. comp. physiol. Psychol ., 1964, 57, 127-133. 81

PAGE 88

82 Church, R. M. The varied effects of punishment on behavior. Psychol. Rev ., 1963, 70_, 369-402. Clark, D. F. Fetishism treated by negative conditioning. Brit. J. Psychiat ., 1963, 109 , 404-407. Coates, S. Clinical psychology in sexual deviation. In I. Rosen (Ed.), The pathology ajid treatment of sexual deviation, a methodological approach . London: Oxford University Press, 1964. Cooper, A. J. A case of fetishism and impotence treated by behavior therapy. Brit. J. Psychiat ., 1963, 109 , 649652. Estes, W. K. An experimental study of punishment. Psychol . Monogr ., 1944, 57 (3, Whole No. 263). Eysenck, H. J. Behavior therapy, extinction and relapse in neurosis. Brit. J. Psychiat ., 1963, 109 , 12-18. Eysenck, H. J., and Rachraan , S. Causes and cures of neurosis . Sam Diego, Calif.: Robert Knapp, 1965. Feldman, M. P. Aversion therapy for sexual deviations. Psychol , Bull., 1966, 65, 56-79. Feldman, M. P., and MacCulloch, M. J. The application of anticipatory avoidance learning to the treatment of homosexuality. Behav. Res. Ther ., 1965, 2, 165-183. Fine, B. J., Marchesani, M., and Sweeney, D, R, A bibliography on the psychological aspects of smoking: January 1940 through September 1965. Psychol. Rep ., 1966, 18^, 783787. Franks, C. M. Alcohol, alcoholism, and conditioning. J. ment . Sci . , 1958, 104 , 14-33. Franks, C. M. Behavior therapy, the principles of conditioning, and the treatment of the alcoholic. Quart. J. stud. Ale , 1963, 24, 511-529. Franks, C. M. Conditioning techniques in clinical practice and research . New York: Springer, 1964. Franks, C. M. , Fried, R., and Ashem, B. An improved apparatus for the aversive conditioning of cigaret smokers. Behav. Res. Ther ., 1966, 4, 301-308. Gantt, W. H. Experimental basis for neurotic behavior . New York: Hoeber, 1944.

PAGE 89

83 Goldiamond, I. Stuttering and fluency as nanipulatable operant response classes. In L. Krasner and LP. Ullmann (Eds.), Research in behavior modification . New York: Holt, Rinehart and Winston, 1965. Goodman, L. So, and Gilp-ri, A.^ The pharmacological basis of therapeutics . N York: Macmillan, 1960. Greene, R. J. Modification of smoking behavior by free operant conditioning methods. Psychol. Rec . , 1964, 14, 171-178. Hammond, E. C. , and Percy, C. Ex-smokerSc N. Y. State J. Med . , 1958 (Sept.), 2956-2959. Holz, W, , and Azrin, N. H. rdscriminative properties of punishment. J . expo Anal. Behav ., 1961, 4, 225-232. Holz, W., and Azrin, N. H. Interactions between the discriminative and aversivG properties of punishment. J . e>cp. Anal. Behav . , 1962, 5^, 225-232 » Hsu, J. J, Electrocondi tioning therapy of alcoholism. Quarto J. Stud. Ale , 1965, 26, 449-459 c Hull, C. L. E ssentials of behavior . New Haven: Yale University Press, 1951. Karsh, E. Effects of number of rewarded trials and intensity of punishment on running speed. J. comp. phys iol. Psychol . , 1962, 55, 44-51. Kimble, G. A. Hilgard and Marquis^ condi tioning and learnir ig. New York: Appleton-Century-Crof ts , 1961. Koenig, K. P., and Masters, J. Experimental treatment of habitual smoking. Behav. Res. Ther. , 1965, 3, 235-243. Kushner, M. The reduction of a long-standing fetish by means of aversive conditioning. In Lo P. Ullmann and L. Krasner (Eda), Case studies in b ehavi or m odificatio n. New York: Holt, Rinehart and Winston, 1965. Kushner, M. and Sandler, J. Aversion therapy and the concept of punishment. Behav. Res. Ther ., 1966, 4, 179-186. Lazarus, A. A. The results of behavior therapy in 126 cases of severe neurosis. B ehav. Res. Th er., 1963, 1, 69-79. MacCulloch, M. J., Feldman, M. P., Orford, J. F. , and MacCulloch, M. L. i^j-iticipatory avoidance learning in the treatment of alcoholism: A record of therapeutic failure. Behav, Res. Ther . , 1966, 4, 187-196.

PAGE 90

84 Maier, N. R. F. Frustration: The study of behavior without a goal . New York: McGraw-Hill ,~T949 . Martin, B. Reward and punishment associated with the same goal response: A factor in the learning of motives. Psychol. Bull ., 1963, 60, 441-451. Martin, B. , and Ross, L. E. Consumatory response punishment. J. com p. ghysiol . Psychol ., 1964, 58, 243-247. Masserman, J. M. Behavior and neurosis . Chicago: University of Chicago Press, 1943. Masserman, Jc M. , and Pectel, C. Neurosis in monkeys: A preliminary report of experimental observations. Ann . N. Y. Acad. Sci ., 1953, 56^, 253-265. Matterazzo, J. D. , and Saslow, G. Psychological and related characteristics of smokers and nonsmokerSo Psychol o Bull . , 1960, 57, 493-513. McGuire, R. J,, and Vallance, M. Aversion therapy by electric shock. Brit, med. J ., 1964, 1^, 151-153. McNaraara, H. J., and Wike, E. L. The effects of irregular learning conditions upon the rate and permanence of learning. J. comp. physiol. Psycho l., 1958, 51_5 363-366. Mees, H. L. Sadistic fantasies modified by aversive conditioning and substitution: A case study. Beh^xv. Res. Ther. , 1966, 4, 317-320. Meyer, V. and Crisp, A. H. Aversion therapy in two cases of obesity. Behav. ReSo Ther ., 1964, 2, 143-147. Meyer, V. and Crisp, A. H. Some problems in behavior therapy. Brit . J. Psychi at., 1966, 112, 367-381. Meyer, V. , and Gelder, M. G. Behavior therapy and phobic disorders. Brito J. Psychiat ., 1963, 109 , 19-28. Miller, N. E. Learning resistance to pain and fear: Effects of overlearning , exposure, and rewarded exposure in context. J. exp. Psychol ., 1960, 60, 137-145. Mowrer, O. H. L earning theory and behavior . New York: John Wiley and Sons, 1960. Muenzinger, K. F. , Bernstone, A. H. , and Richards, L. Motivation in learning: VIII ^ Equivalent amounts of electric shock for right and wrong responses in a visual discrimination habit, J» com p. physiol. P sychol . 1938, 26, 177-186.

PAGE 91

85 Muenzinger, K. F. , and Powloski , R. E. Motivation in learning: X. Comparison of electric shock for correct turns in a corrective and non-corrective situation. J. exp . Psychol . , 1951, 42, 118-124. Ober, D. C. The modification of smoking behavior. Unpublished doctoral dissertation, tJniversity of Illinois, 1967. Oswald, I. Induction of illusory and hallucinatory voices. J. ment. Sci . , 1962, 108 , 196-212. Prince, A. I. Effect of punishment on visual discrimination learning. J. exp. Psychol . , 1956, 52, 381-385. Pyke, S. , Agnew, N.M., and Kopperud, J. Modification of an overlearned maladaptive response through a relearning prograim: A pilot study on smoking. Behav . Res. Ther ., 1966, 4, 197-203. Rachmaji, S. Aversion therapy: Chemical or electrical? Behav . Res . Ther . , 1965, 2_, 289-299. Raymond, M. J. Case of fetishism treated by aversion therapy. Brit, med. J . , 1956, 2_, 854-857. Rosenthal, R, Experimenter effects in behavioral research . New York: Appleton-Century-Crof ts , 1966. Sanderson, R. E. An investigation of a new aversive conditioning therapy for alcoholism. Creative talents awards pro gram , Series 3. Washington: American Institute for Research, 1963, 39-43 Sandler, J. Masochism: An empirical analysis. Psychol . Bull . , 1964, 62_, 197-204. Skinner, B. F. Walden two . New York: Macmillan, 1948. Skinner, B. F. Science and human behavior . New York: Macmillan, 1953. Smoking and health: Report of the advisory committee to the Surgeon General of the Public Health Service. Washington, D. C. : U. S. Dept . Hlth. , Educ. and Welf . , 1964. (P. H. S. Publ. No. 1103) Solomon, R. L. Punishment. Amer. Psychol . , 1964, 19_, 239-253. Solomon, R. L. , and Wynne, L. C. Traumatic avoidance learning: Acquisition in normal dogs. Psychol. Monogr . , 1953, 67, 1-19. Tate, B. G. , and Baroff, G. S. Aversive control of selfinjurious behavior in a psychotic boy. Behav . Res . Ther., 1966, 4, 281-287.

PAGE 92

86 Thorndike, E. L. Reward and punishment in animal learning. Comp. Psychol. Monogr . , 1932, 8 (Whole No. 39). Thorpe, J. G. , and Schmidt, E. Therapeutic failure in a case of aversion therapy. Behav. Res. Ther ., 1963, ]^, 293296. Thorpe, J. G. , Schmidt, E. , Brown, P. T. , andCastell, D. Aversionrelief therapy: A new method for general application. Behav. Res. Ther ., 1964, 2^, 71-82. Thorpe, J. G. , Schmidt, E. , and Castell, D. A comparison of positive and negative (aversive) conditioning in the treatment of homosexuality. Behav. Res. Ther ., 1963, 1, 357-362. Turner, L. H. , and Solomon, R. L. Human traumatic avoidance learning: Theory and experiments on the operantrespondent distinction and failures to learn. Psychol . Monogr . , 1962, 76_ (Whole No. 559). Wilde, G. J. S. Behavior therapy for addicted cigarette smokers: A preliminary investigation. Behav. Res. Ther . , 1964, 2, 101-109. Wolpe, J. Conditioned inhibition of craving in drug addiction; A pilot experiment. Behav. Res. Ther ., 1965, 2_, 285288. Woodworth, R. S. , and Schlosberg, H. Experimental psychology . New York: Holt and Co., 1958.

PAGE 93

BIOGRAPHICAL SKETCH Michael Samuel Stokols was born in Chicago, Illinois, on September 11, 1938, and mo\fbd to Miami, Florida, with his family at the age of six. He graduated from Miami Senior High School in 1956, attended the University of Florida from September, 1956 to June, 1958, and received the Bachelor of Arts degree with a major in Psychology and minor in Biology from the University of Miami (Florida) in January, 1960. Mr. Stokols entered the Graduate School of the University of South Carolina in February, 1961, and received the Master of Science degree in Psychology from this institution in August, 1962. Since entering the Graduate School of the University of Florida in September, 1962, he has been engaged in fulfilling the requirements for the degree of Doctor of Philosophy in Clinical Psychology. Mr. Stokols' financial support while at the University of Florida has included an assistant ship in the Reading Clinic, traineeships through the Department of Vocational Rehabilitation, and participation in the Veterans Administration Psychology Assistantship Program. In May, 1967, he completed a predoctoral internship) in clinical psychology at the Edivard G. Hines Veterans Administration Hospital, Hines, Illinois. Mr. Stokols is presently employed as a Clinical Psychologist, Level III, at the Illinois State Pediatric Institute, Chicago, Illinois. 87

PAGE 94

This dissertation was prepared under the direction of the chairman of the candidate's supervisory committee and has been approved by all members of that committee. It was submitted to the Dean of the College of Arts and Sciences and to the Graduate Council, and was approved as partial fulfillment of the requirements for the degree of Doctor of Philosophy. December , 1968 Supervisory Committee; li^" h kill. Dean, Graduate School ^<^.a^^ jH^ ^_ \^6-^uJvv


xml version 1.0 encoding UTF-8 standalone no
fcla fda yes
dl
!-- comparison of the differential effects four aversive procedures utilizing electric shock on smoking behavior ( Book ) --
METS:mets OBJID UF00097813_00001
xmlns:METS http:www.loc.govMETS
xmlns:mods http:www.loc.govmodsv3
xmlns:xlink http:www.w3.org1999xlink
xmlns:xsi http:www.w3.org2001XMLSchema-instance
xmlns:daitss http:www.fcla.edudlsmddaitss
xmlns:sobekcm http:digital.uflib.ufl.edumetadatasobekcm
xsi:schemaLocation
http:www.loc.govstandardsmetsmets.xsd
http:www.loc.govmodsv3mods-3-3.xsd
http:www.fcla.edudlsmddaitssdaitss.xsd
http:digital.uflib.ufl.edumetadatasobekcmsobekcm.xsd
METS:metsHdr CREATEDATE 2010-09-20T08:54:46Z ID LASTMODDATE 2010-02-04T00:00:00Z RECORDSTATUS NEW
METS:agent ROLE CREATOR TYPE ORGANIZATION
METS:name UF
METS:note server=TC
projects=
OTHERTYPE SOFTWARE OTHER
Go UFDC - FDA Preparation Tool
INDIVIDUAL
UFAD\mariner1
METS:dmdSec DMD1
METS:mdWrap MDTYPE MODS MIMETYPE textxml LABEL Metadata
METS:xmlData
mods:mods
mods:genre authority marcgt bibliography
non-fiction
mods:identifier type AlephBibNum 000554628
OCLC 13418863
NOTIS ACX9473
mods:language
mods:languageTerm text English
code iso639-2b eng
mods:location
mods:physicalLocation University of Florida
UF
mods:name personal
mods:namePart Stokols, Michael Samuel
given Michael Samuel
family Stokols
date 1938-
mods:role
mods:roleTerm Main Entity
mods:note thesis Thesis - University of Florida.
bibliography Bibliography: leaves 81-86.
additional physical form Also available on World Wide Web
Manuscript copy.
Vita.
mods:originInfo
mods:place
mods:placeTerm marccountry xx
mods:dateIssued marc 1968
point start 1968
mods:copyrightDate 1968
mods:recordInfo
mods:recordIdentifier source ufdc UF00097813_00001
mods:recordCreationDate 860411
mods:recordOrigin Imported from (ALEPH)000554628
mods:recordContentSource University of Florida
marcorg fug
FUG
mods:languageOfCataloging
English
eng
mods:relatedItem original
mods:physicalDescription
mods:extent v, 87 leaves : illus. ; 28 cm.
mods:subject SUBJ650_1 lcsh
mods:topic Aversive stimuli
SUBJ650_2
Smoking
SUBJ690_1
Psychology thesis Ph. D
SUBJ690_2
Dissertations, Academic
Psychology
mods:geographic UF
mods:titleInfo
mods:nonSort A
mods:title comparison of the differential effects of four aversive procedures utilizing electric shock on smoking behavior
mods:typeOfResource text
DMD2
OTHERMDTYPE SobekCM Custom
sobekcm:procParam
sobekcm:Collection.Primary UFIR
sobekcm:Collection.Alternate VENDORIA
sobekcm:SubCollection UFETD
sobekcm:MainThumbnail comparisonofdiff00stokrich_Page_01thm.jpg
sobekcm:Download
sobekcm:fptr FILEID UR2
sobekcm:EncodingLevel I
sobekcm:bibDesc
sobekcm:BibID UF00097813
sobekcm:VID 00001
sobekcm:Source
sobekcm:statement UF University of Florida
sobekcm:Type Book
sobekcm:SortDate -1
METS:amdSec
METS:digiprovMD AMD_DAITSS
DAITSS
daitss:daitss
daitss:AGREEMENT_INFO ACCOUNT PROJECT UFDC
METS:fileSec
METS:fileGrp USE reference
METS:file GROUPID G1 J1 imagejpeg SIZE 127994
METS:FLocat LOCTYPE OTHERLOCTYPE SYSTEM xlink:href comparisonofdiff00stokrich_Page_01.jpg
G2 J2 57678
comparisonofdiff00stokrich_Page_02.jpg
G3 J3 163120
comparisonofdiff00stokrich_Page_03.jpg
G4 J4 139114
comparisonofdiff00stokrich_Page_04.jpg
G5 J5 269808
comparisonofdiff00stokrich_Page_05.jpg
G6 J6 58018
comparisonofdiff00stokrich_Page_06.jpg
G7 J7 229538
comparisonofdiff00stokrich_Page_07.jpg
G8 J8 270051
comparisonofdiff00stokrich_Page_08.jpg
G9 J9 293451
comparisonofdiff00stokrich_Page_09.jpg
G10 J10 256603
comparisonofdiff00stokrich_Page_10.jpg
G11 J11 265471
comparisonofdiff00stokrich_Page_11.jpg
G12 J12 274060
comparisonofdiff00stokrich_Page_12.jpg
G13 J13 260938
comparisonofdiff00stokrich_Page_13.jpg
G14 J14 265266
comparisonofdiff00stokrich_Page_14.jpg
G15 J15 287586
comparisonofdiff00stokrich_Page_15.jpg
G16 J16 272477
comparisonofdiff00stokrich_Page_16.jpg
G17 J17 278031
comparisonofdiff00stokrich_Page_17.jpg
G18 J18 268293
comparisonofdiff00stokrich_Page_18.jpg
G19 J19 268716
comparisonofdiff00stokrich_Page_19.jpg
G20 J20 269280
comparisonofdiff00stokrich_Page_20.jpg
G21 J21 272241
comparisonofdiff00stokrich_Page_21.jpg
G22 J22 251900
comparisonofdiff00stokrich_Page_22.jpg
G23 J23 271923
comparisonofdiff00stokrich_Page_23.jpg
G24 J24 278949
comparisonofdiff00stokrich_Page_24.jpg
G25 J25 270928
comparisonofdiff00stokrich_Page_25.jpg
G26 J26 247505
comparisonofdiff00stokrich_Page_26.jpg
G27 J27 272229
comparisonofdiff00stokrich_Page_27.jpg
G28 J28 264767
comparisonofdiff00stokrich_Page_28.jpg
G29 J29 292735
comparisonofdiff00stokrich_Page_29.jpg
G30 J30 260316
comparisonofdiff00stokrich_Page_30.jpg
G31 J31 281582
comparisonofdiff00stokrich_Page_31.jpg
G32 J32 252504
comparisonofdiff00stokrich_Page_32.jpg
G33 J33 274139
comparisonofdiff00stokrich_Page_33.jpg
G34 J34 251127
comparisonofdiff00stokrich_Page_34.jpg
G35 J35 301600
comparisonofdiff00stokrich_Page_35.jpg
G36 J36 227107
comparisonofdiff00stokrich_Page_36.jpg
G37 J37 252734
comparisonofdiff00stokrich_Page_37.jpg
G38 J38 220530
comparisonofdiff00stokrich_Page_38.jpg
G39 J39 260917
comparisonofdiff00stokrich_Page_39.jpg
G40 J40 273736
comparisonofdiff00stokrich_Page_40.jpg
G41 J41 285186
comparisonofdiff00stokrich_Page_41.jpg
G42 J42 263458
comparisonofdiff00stokrich_Page_42.jpg
G43 J43 292280
comparisonofdiff00stokrich_Page_43.jpg
G44 J44 276130
comparisonofdiff00stokrich_Page_44.jpg
G45 J45 268139
comparisonofdiff00stokrich_Page_45.jpg
G46 J46 254597
comparisonofdiff00stokrich_Page_46.jpg
G47 J47 257629
comparisonofdiff00stokrich_Page_47.jpg
G48 J48 289940
comparisonofdiff00stokrich_Page_48.jpg
G49 J49 268879
comparisonofdiff00stokrich_Page_49.jpg
G50 J50 182897
comparisonofdiff00stokrich_Page_50.jpg
G51 J51 222836
comparisonofdiff00stokrich_Page_51.jpg
G52 J52 263743
comparisonofdiff00stokrich_Page_52.jpg
G53 J53 172170
comparisonofdiff00stokrich_Page_53.jpg
G54 J54 199993
comparisonofdiff00stokrich_Page_54.jpg
G55 J55 268532
comparisonofdiff00stokrich_Page_55.jpg
G56 J56 188788
comparisonofdiff00stokrich_Page_56.jpg
G57 J57 224517
comparisonofdiff00stokrich_Page_57.jpg
G58 J58 201649
comparisonofdiff00stokrich_Page_58.jpg
G59 J59 230412
comparisonofdiff00stokrich_Page_59.jpg
G60 J60 220979
comparisonofdiff00stokrich_Page_60.jpg
G61 J61 247793
comparisonofdiff00stokrich_Page_61.jpg
G62 J62 270941
comparisonofdiff00stokrich_Page_62.jpg
G63 J63 192734
comparisonofdiff00stokrich_Page_63.jpg
G64 J64 217988
comparisonofdiff00stokrich_Page_64.jpg
G65 J65 275944
comparisonofdiff00stokrich_Page_65.jpg
G66 J66 290985
comparisonofdiff00stokrich_Page_66.jpg
G67 J67 280098
comparisonofdiff00stokrich_Page_67.jpg
G68 J68 263119
comparisonofdiff00stokrich_Page_68.jpg
G69 J69 283351
comparisonofdiff00stokrich_Page_69.jpg
G70 J70 268135
comparisonofdiff00stokrich_Page_70.jpg
G71 J71 283214
comparisonofdiff00stokrich_Page_71.jpg
G72 J72 264835
comparisonofdiff00stokrich_Page_72.jpg
G73 J73 302731
comparisonofdiff00stokrich_Page_73.jpg
G74 J74 235487
comparisonofdiff00stokrich_Page_74.jpg
G75 J75 276565
comparisonofdiff00stokrich_Page_75.jpg
G76 J76 258586
comparisonofdiff00stokrich_Page_76.jpg
G77 J77 283716
comparisonofdiff00stokrich_Page_77.jpg
G78 J78 123369
comparisonofdiff00stokrich_Page_78.jpg
G79 J79 237433
comparisonofdiff00stokrich_Page_79.jpg
G80 J80 233242
comparisonofdiff00stokrich_Page_80.jpg
G81 J81 239371
comparisonofdiff00stokrich_Page_81.jpg
G82 J82 37241
comparisonofdiff00stokrich_Page_82.jpg
G83 J83 196370
comparisonofdiff00stokrich_Page_83.jpg
G84 J84 290679
comparisonofdiff00stokrich_Page_84.jpg
G85 J85 155753
comparisonofdiff00stokrich_Page_85.jpg
G86 J86 106228
comparisonofdiff00stokrich_Page_86.jpg
G87 J87 264522
comparisonofdiff00stokrich_Page_87.jpg
G88 J88 295316
comparisonofdiff00stokrich_Page_88.jpg
G89 J89 305507
comparisonofdiff00stokrich_Page_89.jpg
G90 J90 286114
comparisonofdiff00stokrich_Page_90.jpg
G91 J91 335365
comparisonofdiff00stokrich_Page_91.jpg
G92 J92 191503
comparisonofdiff00stokrich_Page_92.jpg
G93 J93 236731
comparisonofdiff00stokrich_Page_93.jpg
G94 J94 164120
comparisonofdiff00stokrich_Page_94.jpg
E1 imagejp2 267197
comparisonofdiff00stokrich_Page_01.jp2
E2 101035
comparisonofdiff00stokrich_Page_02.jp2
E3 430441
comparisonofdiff00stokrich_Page_03.jp2
E4 343148
comparisonofdiff00stokrich_Page_04.jp2
E5 514145
comparisonofdiff00stokrich_Page_05.jp2
E6 90336
comparisonofdiff00stokrich_Page_06.jp2
E7 514161
comparisonofdiff00stokrich_Page_07.jp2
E8 514150
comparisonofdiff00stokrich_Page_08.jp2
E9 514142
comparisonofdiff00stokrich_Page_09.jp2
E10 514154
comparisonofdiff00stokrich_Page_10.jp2
E11 514137
comparisonofdiff00stokrich_Page_11.jp2
E12 514130
comparisonofdiff00stokrich_Page_12.jp2
E13
comparisonofdiff00stokrich_Page_13.jp2
E14 514126
comparisonofdiff00stokrich_Page_14.jp2
E15
comparisonofdiff00stokrich_Page_15.jp2
E16 514106
comparisonofdiff00stokrich_Page_16.jp2
E17 514147
comparisonofdiff00stokrich_Page_17.jp2
E18 514158
comparisonofdiff00stokrich_Page_18.jp2
E19
comparisonofdiff00stokrich_Page_19.jp2
E20 514123
comparisonofdiff00stokrich_Page_20.jp2
E21 514099
comparisonofdiff00stokrich_Page_21.jp2
E22
comparisonofdiff00stokrich_Page_22.jp2
E23 514079
comparisonofdiff00stokrich_Page_23.jp2
E24 514156
comparisonofdiff00stokrich_Page_24.jp2
E25 514139
comparisonofdiff00stokrich_Page_25.jp2
E26 514140
comparisonofdiff00stokrich_Page_26.jp2
E27 514128
comparisonofdiff00stokrich_Page_27.jp2
E28 514121
comparisonofdiff00stokrich_Page_28.jp2
E29
comparisonofdiff00stokrich_Page_29.jp2
E30
comparisonofdiff00stokrich_Page_30.jp2
E31
comparisonofdiff00stokrich_Page_31.jp2
E32 514025
comparisonofdiff00stokrich_Page_32.jp2
E33
comparisonofdiff00stokrich_Page_33.jp2
E34 514152
comparisonofdiff00stokrich_Page_34.jp2
E35
comparisonofdiff00stokrich_Page_35.jp2
E36 514132
comparisonofdiff00stokrich_Page_36.jp2
E37 514148
comparisonofdiff00stokrich_Page_37.jp2
E38
comparisonofdiff00stokrich_Page_38.jp2
E39
comparisonofdiff00stokrich_Page_39.jp2
E40 514157
comparisonofdiff00stokrich_Page_40.jp2
E41 514144
comparisonofdiff00stokrich_Page_41.jp2
E42 514115
comparisonofdiff00stokrich_Page_42.jp2
E43
comparisonofdiff00stokrich_Page_43.jp2
E44 514134
comparisonofdiff00stokrich_Page_44.jp2
E45 514074
comparisonofdiff00stokrich_Page_45.jp2
E46 514138
comparisonofdiff00stokrich_Page_46.jp2
E47 514133
comparisonofdiff00stokrich_Page_47.jp2
E48 514111
comparisonofdiff00stokrich_Page_48.jp2
E49 514160
comparisonofdiff00stokrich_Page_49.jp2
E50 486376
comparisonofdiff00stokrich_Page_50.jp2
E51
comparisonofdiff00stokrich_Page_51.jp2
E52
comparisonofdiff00stokrich_Page_52.jp2
E53 426122
comparisonofdiff00stokrich_Page_53.jp2
E54 514124
comparisonofdiff00stokrich_Page_54.jp2
E55
comparisonofdiff00stokrich_Page_55.jp2
E56 493011
comparisonofdiff00stokrich_Page_56.jp2
E57
comparisonofdiff00stokrich_Page_57.jp2
E58
comparisonofdiff00stokrich_Page_58.jp2
E59
comparisonofdiff00stokrich_Page_59.jp2
E60 514151
comparisonofdiff00stokrich_Page_60.jp2
E61 514155
comparisonofdiff00stokrich_Page_61.jp2
E62 514052
comparisonofdiff00stokrich_Page_62.jp2
E63 502394
comparisonofdiff00stokrich_Page_63.jp2
E64
comparisonofdiff00stokrich_Page_64.jp2
E65
comparisonofdiff00stokrich_Page_65.jp2
E66 514135
comparisonofdiff00stokrich_Page_66.jp2
E67 514141
comparisonofdiff00stokrich_Page_67.jp2
E68 514143
comparisonofdiff00stokrich_Page_68.jp2
E69
comparisonofdiff00stokrich_Page_69.jp2
E70
comparisonofdiff00stokrich_Page_70.jp2
E71 514122
comparisonofdiff00stokrich_Page_71.jp2
E72
comparisonofdiff00stokrich_Page_72.jp2
E73
comparisonofdiff00stokrich_Page_73.jp2
E74 514159
comparisonofdiff00stokrich_Page_74.jp2
E75
comparisonofdiff00stokrich_Page_75.jp2
E76
comparisonofdiff00stokrich_Page_76.jp2
E77
comparisonofdiff00stokrich_Page_77.jp2
E78 287233
comparisonofdiff00stokrich_Page_78.jp2
E79
comparisonofdiff00stokrich_Page_79.jp2
E80 514149
comparisonofdiff00stokrich_Page_80.jp2
E81 514146
comparisonofdiff00stokrich_Page_81.jp2
E82 27878
comparisonofdiff00stokrich_Page_82.jp2
E83 504754
comparisonofdiff00stokrich_Page_83.jp2
E84 514127
comparisonofdiff00stokrich_Page_84.jp2
E85 373668
comparisonofdiff00stokrich_Page_85.jp2
E86 248608
comparisonofdiff00stokrich_Page_86.jp2
E87 514153
comparisonofdiff00stokrich_Page_87.jp2
E88
comparisonofdiff00stokrich_Page_88.jp2
E89
comparisonofdiff00stokrich_Page_89.jp2
E90 514105
comparisonofdiff00stokrich_Page_90.jp2
E91
comparisonofdiff00stokrich_Page_91.jp2
E92
comparisonofdiff00stokrich_Page_92.jp2
E93 514076
comparisonofdiff00stokrich_Page_93.jp2
E94 429173
comparisonofdiff00stokrich_Page_94.jp2
archive
F1 imagetiff 6.0 12356476
comparisonofdiff00stokrich_Page_01.tif
F2
comparisonofdiff00stokrich_Page_02.tif
F3
comparisonofdiff00stokrich_Page_03.tif
F4
comparisonofdiff00stokrich_Page_04.tif
F5
comparisonofdiff00stokrich_Page_05.tif
F6
comparisonofdiff00stokrich_Page_06.tif
F7
comparisonofdiff00stokrich_Page_07.tif
F8
comparisonofdiff00stokrich_Page_08.tif
F9
comparisonofdiff00stokrich_Page_09.tif
F10
comparisonofdiff00stokrich_Page_10.tif
F11
comparisonofdiff00stokrich_Page_11.tif
F12
comparisonofdiff00stokrich_Page_12.tif
F13
comparisonofdiff00stokrich_Page_13.tif
F14
comparisonofdiff00stokrich_Page_14.tif
F15
comparisonofdiff00stokrich_Page_15.tif
F16
comparisonofdiff00stokrich_Page_16.tif
F17
comparisonofdiff00stokrich_Page_17.tif
F18
comparisonofdiff00stokrich_Page_18.tif
F19
comparisonofdiff00stokrich_Page_19.tif
F20
comparisonofdiff00stokrich_Page_20.tif
F21
comparisonofdiff00stokrich_Page_21.tif
F22
comparisonofdiff00stokrich_Page_22.tif
F23
comparisonofdiff00stokrich_Page_23.tif
F24
comparisonofdiff00stokrich_Page_24.tif
F25
comparisonofdiff00stokrich_Page_25.tif
F26
comparisonofdiff00stokrich_Page_26.tif
F27
comparisonofdiff00stokrich_Page_27.tif
F28
comparisonofdiff00stokrich_Page_28.tif
F29
comparisonofdiff00stokrich_Page_29.tif
F30
comparisonofdiff00stokrich_Page_30.tif
F31
comparisonofdiff00stokrich_Page_31.tif
F32
comparisonofdiff00stokrich_Page_32.tif
F33
comparisonofdiff00stokrich_Page_33.tif
F34
comparisonofdiff00stokrich_Page_34.tif
F35
comparisonofdiff00stokrich_Page_35.tif
F36
comparisonofdiff00stokrich_Page_36.tif
F37
comparisonofdiff00stokrich_Page_37.tif
F38
comparisonofdiff00stokrich_Page_38.tif
F39
comparisonofdiff00stokrich_Page_39.tif
F40
comparisonofdiff00stokrich_Page_40.tif
F41
comparisonofdiff00stokrich_Page_41.tif
F42
comparisonofdiff00stokrich_Page_42.tif
F43
comparisonofdiff00stokrich_Page_43.tif
F44
comparisonofdiff00stokrich_Page_44.tif
F45
comparisonofdiff00stokrich_Page_45.tif
F46
comparisonofdiff00stokrich_Page_46.tif
F47
comparisonofdiff00stokrich_Page_47.tif
F48
comparisonofdiff00stokrich_Page_48.tif
F49
comparisonofdiff00stokrich_Page_49.tif
F50
comparisonofdiff00stokrich_Page_50.tif
F51
comparisonofdiff00stokrich_Page_51.tif
F52
comparisonofdiff00stokrich_Page_52.tif
F53
comparisonofdiff00stokrich_Page_53.tif
F54
comparisonofdiff00stokrich_Page_54.tif
F55
comparisonofdiff00stokrich_Page_55.tif
F56
comparisonofdiff00stokrich_Page_56.tif
F57
comparisonofdiff00stokrich_Page_57.tif
F58
comparisonofdiff00stokrich_Page_58.tif
F59
comparisonofdiff00stokrich_Page_59.tif
F60
comparisonofdiff00stokrich_Page_60.tif
F61
comparisonofdiff00stokrich_Page_61.tif
F62
comparisonofdiff00stokrich_Page_62.tif
F63
comparisonofdiff00stokrich_Page_63.tif
F64
comparisonofdiff00stokrich_Page_64.tif
F65
comparisonofdiff00stokrich_Page_65.tif
F66
comparisonofdiff00stokrich_Page_66.tif
F67
comparisonofdiff00stokrich_Page_67.tif
F68
comparisonofdiff00stokrich_Page_68.tif
F69
comparisonofdiff00stokrich_Page_69.tif
F70
comparisonofdiff00stokrich_Page_70.tif
F71
comparisonofdiff00stokrich_Page_71.tif
F72
comparisonofdiff00stokrich_Page_72.tif
F73
comparisonofdiff00stokrich_Page_73.tif
F74
comparisonofdiff00stokrich_Page_74.tif
F75
comparisonofdiff00stokrich_Page_75.tif
F76
comparisonofdiff00stokrich_Page_76.tif
F77
comparisonofdiff00stokrich_Page_77.tif
F78
comparisonofdiff00stokrich_Page_78.tif
F79
comparisonofdiff00stokrich_Page_79.tif
F80
comparisonofdiff00stokrich_Page_80.tif
F81
comparisonofdiff00stokrich_Page_81.tif
F82
comparisonofdiff00stokrich_Page_82.tif
F83
comparisonofdiff00stokrich_Page_83.tif
F84
comparisonofdiff00stokrich_Page_84.tif
F85
comparisonofdiff00stokrich_Page_85.tif
F86
comparisonofdiff00stokrich_Page_86.tif
F87
comparisonofdiff00stokrich_Page_87.tif
F88
comparisonofdiff00stokrich_Page_88.tif
F89
comparisonofdiff00stokrich_Page_89.tif
F90
comparisonofdiff00stokrich_Page_90.tif
F91
comparisonofdiff00stokrich_Page_91.tif
F92
comparisonofdiff00stokrich_Page_92.tif
F93
comparisonofdiff00stokrich_Page_93.tif
F94
comparisonofdiff00stokrich_Page_94.tif
R1 textx-pro 8822
comparisonofdiff00stokrich_Page_01.pro
R3 22157
comparisonofdiff00stokrich_Page_03.pro
R4 24634
comparisonofdiff00stokrich_Page_04.pro
R5 45529
comparisonofdiff00stokrich_Page_05.pro
R6 4451
comparisonofdiff00stokrich_Page_06.pro
R7 32071
comparisonofdiff00stokrich_Page_07.pro
R8 41670
comparisonofdiff00stokrich_Page_08.pro
R9 40915
comparisonofdiff00stokrich_Page_09.pro
R10 37820
comparisonofdiff00stokrich_Page_10.pro
R11 37603
comparisonofdiff00stokrich_Page_11.pro
R12 41504
comparisonofdiff00stokrich_Page_12.pro
R13 40609
comparisonofdiff00stokrich_Page_13.pro
R14 39124
comparisonofdiff00stokrich_Page_14.pro
R15 40483
comparisonofdiff00stokrich_Page_15.pro
R16 40150
comparisonofdiff00stokrich_Page_16.pro
R17 38522
comparisonofdiff00stokrich_Page_17.pro
R18 40424
comparisonofdiff00stokrich_Page_18.pro
R19 38804
comparisonofdiff00stokrich_Page_19.pro
R20 40893
comparisonofdiff00stokrich_Page_20.pro
R21 38121
comparisonofdiff00stokrich_Page_21.pro
R22 37226
comparisonofdiff00stokrich_Page_22.pro
R23 38280
comparisonofdiff00stokrich_Page_23.pro
R24 40613
comparisonofdiff00stokrich_Page_24.pro
R25 37807
comparisonofdiff00stokrich_Page_25.pro
R26 37898
comparisonofdiff00stokrich_Page_26.pro
R27 37968
comparisonofdiff00stokrich_Page_27.pro
R28 39007
comparisonofdiff00stokrich_Page_28.pro
R29 41810
comparisonofdiff00stokrich_Page_29.pro
R30 38042
comparisonofdiff00stokrich_Page_30.pro
R31 39832
comparisonofdiff00stokrich_Page_31.pro
R32 39438
comparisonofdiff00stokrich_Page_32.pro
R33 38781
comparisonofdiff00stokrich_Page_33.pro
R34 36904
comparisonofdiff00stokrich_Page_34.pro
R35 43348
comparisonofdiff00stokrich_Page_35.pro
R36 32319
comparisonofdiff00stokrich_Page_36.pro
R37 36283
comparisonofdiff00stokrich_Page_37.pro
R38 36612
comparisonofdiff00stokrich_Page_38.pro
R39 36940
comparisonofdiff00stokrich_Page_39.pro
R40 39402
comparisonofdiff00stokrich_Page_40.pro
R41 40303
comparisonofdiff00stokrich_Page_41.pro
R42 39245
comparisonofdiff00stokrich_Page_42.pro
R43 35352
comparisonofdiff00stokrich_Page_43.pro
R44 36041
comparisonofdiff00stokrich_Page_44.pro
R45 60726
comparisonofdiff00stokrich_Page_45.pro
R46 38947
comparisonofdiff00stokrich_Page_46.pro
R47 40062
comparisonofdiff00stokrich_Page_47.pro
R48 43921
comparisonofdiff00stokrich_Page_48.pro
R49 42013
comparisonofdiff00stokrich_Page_49.pro
R50 24989
comparisonofdiff00stokrich_Page_50.pro
R51 34254
comparisonofdiff00stokrich_Page_51.pro
R52 39594
comparisonofdiff00stokrich_Page_52.pro
R53 9864
comparisonofdiff00stokrich_Page_53.pro
R54 26246
comparisonofdiff00stokrich_Page_54.pro
R55 37270
comparisonofdiff00stokrich_Page_55.pro
R56 12006
comparisonofdiff00stokrich_Page_56.pro
R57 27907
comparisonofdiff00stokrich_Page_57.pro
R58 27351
comparisonofdiff00stokrich_Page_58.pro
R59 29285
comparisonofdiff00stokrich_Page_59.pro
R60 30034
comparisonofdiff00stokrich_Page_60.pro
R61 31543
comparisonofdiff00stokrich_Page_61.pro
R62 41266
comparisonofdiff00stokrich_Page_62.pro
R63 23531
comparisonofdiff00stokrich_Page_63.pro
R64 32052
comparisonofdiff00stokrich_Page_64.pro
R65 38442
comparisonofdiff00stokrich_Page_65.pro
R66 44965
comparisonofdiff00stokrich_Page_66.pro
R67 38841
comparisonofdiff00stokrich_Page_67.pro
R68 39723
comparisonofdiff00stokrich_Page_68.pro
R69 39158
comparisonofdiff00stokrich_Page_69.pro
R70 40335
comparisonofdiff00stokrich_Page_70.pro
R71 38914
comparisonofdiff00stokrich_Page_71.pro
R72 39708
comparisonofdiff00stokrich_Page_72.pro
R73 42237
comparisonofdiff00stokrich_Page_73.pro
R74 39750
comparisonofdiff00stokrich_Page_74.pro
R75 37266
comparisonofdiff00stokrich_Page_75.pro
R76 39801
comparisonofdiff00stokrich_Page_76.pro
R77 39743
comparisonofdiff00stokrich_Page_77.pro
R78 14630
comparisonofdiff00stokrich_Page_78.pro
R79 31242
comparisonofdiff00stokrich_Page_79.pro
R80 37607
comparisonofdiff00stokrich_Page_80.pro
R81 32119
comparisonofdiff00stokrich_Page_81.pro
R82 551
comparisonofdiff00stokrich_Page_82.pro
R83 18957
comparisonofdiff00stokrich_Page_83.pro
R84 30509
comparisonofdiff00stokrich_Page_84.pro
R85 16857
comparisonofdiff00stokrich_Page_85.pro
R86 20272
comparisonofdiff00stokrich_Page_86.pro
R87 37624
comparisonofdiff00stokrich_Page_87.pro
R88 45134
comparisonofdiff00stokrich_Page_88.pro
R89 48970
comparisonofdiff00stokrich_Page_89.pro
R90 48375
comparisonofdiff00stokrich_Page_90.pro
R91 47835
comparisonofdiff00stokrich_Page_91.pro
R92 28007
comparisonofdiff00stokrich_Page_92.pro
R93 34783
comparisonofdiff00stokrich_Page_93.pro
R94 13521
comparisonofdiff00stokrich_Page_94.pro
T1 textplain 512
comparisonofdiff00stokrich_Page_01.txt
T3 969
comparisonofdiff00stokrich_Page_03.txt
T4 1220
comparisonofdiff00stokrich_Page_04.txt
T5 2013
comparisonofdiff00stokrich_Page_05.txt
T6 239
comparisonofdiff00stokrich_Page_06.txt
T7 1420
comparisonofdiff00stokrich_Page_07.txt
T8 1761
comparisonofdiff00stokrich_Page_08.txt
T9 1716
comparisonofdiff00stokrich_Page_09.txt
T10 1614
comparisonofdiff00stokrich_Page_10.txt
T11 1619
comparisonofdiff00stokrich_Page_11.txt
T12 1755
comparisonofdiff00stokrich_Page_12.txt
T13
comparisonofdiff00stokrich_Page_13.txt
T14 1655
comparisonofdiff00stokrich_Page_14.txt
T15 1710
comparisonofdiff00stokrich_Page_15.txt
T16 1690
comparisonofdiff00stokrich_Page_16.txt
T17 1628
comparisonofdiff00stokrich_Page_17.txt
T18 1709
comparisonofdiff00stokrich_Page_18.txt
T19 1642
comparisonofdiff00stokrich_Page_19.txt
T20 1720
comparisonofdiff00stokrich_Page_20.txt
T21
comparisonofdiff00stokrich_Page_21.txt
T22 1586
comparisonofdiff00stokrich_Page_22.txt
T23 1623
comparisonofdiff00stokrich_Page_23.txt
T24 1712
comparisonofdiff00stokrich_Page_24.txt
T25 1625
comparisonofdiff00stokrich_Page_25.txt
T26 1660
comparisonofdiff00stokrich_Page_26.txt
T27 1616
comparisonofdiff00stokrich_Page_27.txt
T28 1646
comparisonofdiff00stokrich_Page_28.txt
T29
comparisonofdiff00stokrich_Page_29.txt
T30 1607
comparisonofdiff00stokrich_Page_30.txt
T31 1703
comparisonofdiff00stokrich_Page_31.txt
T32 1669
comparisonofdiff00stokrich_Page_32.txt
T33 1651
comparisonofdiff00stokrich_Page_33.txt
T34 1569
comparisonofdiff00stokrich_Page_34.txt
T35 1831
comparisonofdiff00stokrich_Page_35.txt
T36 1460
comparisonofdiff00stokrich_Page_36.txt
T37 1587
comparisonofdiff00stokrich_Page_37.txt
T38 1583
comparisonofdiff00stokrich_Page_38.txt
T39 1609
comparisonofdiff00stokrich_Page_39.txt
T40 1711
comparisonofdiff00stokrich_Page_40.txt
T41 1698
comparisonofdiff00stokrich_Page_41.txt
T42 1667
comparisonofdiff00stokrich_Page_42.txt
T43 2132
comparisonofdiff00stokrich_Page_43.txt
T44 2264
comparisonofdiff00stokrich_Page_44.txt
T45 2449
comparisonofdiff00stokrich_Page_45.txt
T46
comparisonofdiff00stokrich_Page_46.txt
T47 1713
comparisonofdiff00stokrich_Page_47.txt
T48 1880
comparisonofdiff00stokrich_Page_48.txt
T49 1775
comparisonofdiff00stokrich_Page_49.txt
T50 1061
comparisonofdiff00stokrich_Page_50.txt
T51 1532
comparisonofdiff00stokrich_Page_51.txt
T52 1673
comparisonofdiff00stokrich_Page_52.txt
T53 720
comparisonofdiff00stokrich_Page_53.txt
T54 1258
comparisonofdiff00stokrich_Page_54.txt
T55 1585
comparisonofdiff00stokrich_Page_55.txt
T56 693
comparisonofdiff00stokrich_Page_56.txt
T57 1328
comparisonofdiff00stokrich_Page_57.txt
T58 1282
comparisonofdiff00stokrich_Page_58.txt
T59 1340
comparisonofdiff00stokrich_Page_59.txt
T60
comparisonofdiff00stokrich_Page_60.txt
T61 1517
comparisonofdiff00stokrich_Page_61.txt
T62 1734
comparisonofdiff00stokrich_Page_62.txt
T63 998
comparisonofdiff00stokrich_Page_63.txt
T64 1406
comparisonofdiff00stokrich_Page_64.txt
T65
comparisonofdiff00stokrich_Page_65.txt
T66 1900
comparisonofdiff00stokrich_Page_66.txt
T67 1637
comparisonofdiff00stokrich_Page_67.txt
T68 1684
comparisonofdiff00stokrich_Page_68.txt
T69 1670
comparisonofdiff00stokrich_Page_69.txt
T70 1705
comparisonofdiff00stokrich_Page_70.txt
T71 1650
comparisonofdiff00stokrich_Page_71.txt
T72
comparisonofdiff00stokrich_Page_72.txt
T73 1787
comparisonofdiff00stokrich_Page_73.txt
T74 1676
comparisonofdiff00stokrich_Page_74.txt
T75
comparisonofdiff00stokrich_Page_75.txt
T76 1683
comparisonofdiff00stokrich_Page_76.txt
T77 1693
comparisonofdiff00stokrich_Page_77.txt
T78 644
comparisonofdiff00stokrich_Page_78.txt
T79 1384
comparisonofdiff00stokrich_Page_79.txt
T80 1601
comparisonofdiff00stokrich_Page_80.txt
T81 1371
comparisonofdiff00stokrich_Page_81.txt
T82 83
comparisonofdiff00stokrich_Page_82.txt
T83 1082
comparisonofdiff00stokrich_Page_83.txt
T84 2084
comparisonofdiff00stokrich_Page_84.txt
T85 1063
comparisonofdiff00stokrich_Page_85.txt
T86 1825
comparisonofdiff00stokrich_Page_86.txt
T87 1746
comparisonofdiff00stokrich_Page_87.txt
T88 2054
comparisonofdiff00stokrich_Page_88.txt
T89 2222
comparisonofdiff00stokrich_Page_89.txt
T90 2183
comparisonofdiff00stokrich_Page_90.txt
T91 2145
comparisonofdiff00stokrich_Page_91.txt
T92 1285
comparisonofdiff00stokrich_Page_92.txt
T93 1490
comparisonofdiff00stokrich_Page_93.txt
T94 661
comparisonofdiff00stokrich_Page_94.txt
applicationpdf 3854880
comparisonofdiff00stokrich.pdf
UR1 32036
comparisonofdiff00stokrich_Page_01thm.jpg
AR1 57027
comparisonofdiff00stokrich_Page_01.QC.jpg
AR2 32675
comparisonofdiff00stokrich_Page_02.QC.jpg
AR3 24264
comparisonofdiff00stokrich_Page_02thm.jpg
AR4 74739
comparisonofdiff00stokrich_Page_03.QC.jpg
AR5 36303
comparisonofdiff00stokrich_Page_03thm.jpg
AR6 71901
comparisonofdiff00stokrich_Page_04.QC.jpg
AR7 34496
comparisonofdiff00stokrich_Page_04thm.jpg
AR8 110279
comparisonofdiff00stokrich_Page_05.QC.jpg
AR9 45502
comparisonofdiff00stokrich_Page_05thm.jpg
AR10 33494
comparisonofdiff00stokrich_Page_06.QC.jpg
AR11 24101
comparisonofdiff00stokrich_Page_06thm.jpg
AR12 101889
comparisonofdiff00stokrich_Page_07.QC.jpg
AR13 44047
comparisonofdiff00stokrich_Page_07thm.jpg
AR14 117033
comparisonofdiff00stokrich_Page_08.QC.jpg
AR15 48764
comparisonofdiff00stokrich_Page_08thm.jpg
AR16 121246
comparisonofdiff00stokrich_Page_09.QC.jpg
AR17 49782
comparisonofdiff00stokrich_Page_09thm.jpg
AR18 109443
comparisonofdiff00stokrich_Page_10.QC.jpg
AR19 45049
comparisonofdiff00stokrich_Page_10thm.jpg
AR20 112574
comparisonofdiff00stokrich_Page_11.QC.jpg
AR21 47853
comparisonofdiff00stokrich_Page_11thm.jpg
AR22 115511
comparisonofdiff00stokrich_Page_12.QC.jpg
AR23 46982
comparisonofdiff00stokrich_Page_12thm.jpg
AR24 110393
comparisonofdiff00stokrich_Page_13.QC.jpg
AR25 46627
comparisonofdiff00stokrich_Page_13thm.jpg
AR26 111038
comparisonofdiff00stokrich_Page_14.QC.jpg
AR27 46611
comparisonofdiff00stokrich_Page_14thm.jpg
AR28 118969
comparisonofdiff00stokrich_Page_15.QC.jpg
AR29 49017
comparisonofdiff00stokrich_Page_15thm.jpg
AR30 115605
comparisonofdiff00stokrich_Page_16.QC.jpg
AR31 47929
comparisonofdiff00stokrich_Page_16thm.jpg
AR32 117603
comparisonofdiff00stokrich_Page_17.QC.jpg
AR33 47198
comparisonofdiff00stokrich_Page_17thm.jpg
AR34 112820
comparisonofdiff00stokrich_Page_18.QC.jpg
AR35 46447
comparisonofdiff00stokrich_Page_18thm.jpg
AR36 113520
comparisonofdiff00stokrich_Page_19.QC.jpg
AR37 47330
comparisonofdiff00stokrich_Page_19thm.jpg
AR38 115673
comparisonofdiff00stokrich_Page_20.QC.jpg
AR39 48078
comparisonofdiff00stokrich_Page_20thm.jpg
AR40 114181
comparisonofdiff00stokrich_Page_21.QC.jpg
AR41 47420
comparisonofdiff00stokrich_Page_21thm.jpg
AR42 107884
comparisonofdiff00stokrich_Page_22.QC.jpg
AR43 45118
comparisonofdiff00stokrich_Page_22thm.jpg
AR44 116267
comparisonofdiff00stokrich_Page_23.QC.jpg
AR45 48181
comparisonofdiff00stokrich_Page_23thm.jpg
AR46 119857
comparisonofdiff00stokrich_Page_24.QC.jpg
AR47 49179
comparisonofdiff00stokrich_Page_24thm.jpg
AR48 112930
comparisonofdiff00stokrich_Page_25.QC.jpg
AR49 46676
comparisonofdiff00stokrich_Page_25thm.jpg
AR50 105339
comparisonofdiff00stokrich_Page_26.QC.jpg
AR51 46670
comparisonofdiff00stokrich_Page_26thm.jpg
AR52 115227
comparisonofdiff00stokrich_Page_27.QC.jpg
AR53 47456
comparisonofdiff00stokrich_Page_27thm.jpg
AR54 111483
comparisonofdiff00stokrich_Page_28.QC.jpg
AR55 46591
comparisonofdiff00stokrich_Page_28thm.jpg
AR56 122334
comparisonofdiff00stokrich_Page_29.QC.jpg
AR57 49494
comparisonofdiff00stokrich_Page_29thm.jpg
AR58 110414
comparisonofdiff00stokrich_Page_30.QC.jpg
AR59 46486
comparisonofdiff00stokrich_Page_30thm.jpg
AR60 118398
comparisonofdiff00stokrich_Page_31.QC.jpg
AR61 49287
comparisonofdiff00stokrich_Page_31thm.jpg
AR62 108476
comparisonofdiff00stokrich_Page_32.QC.jpg
AR63 47329
comparisonofdiff00stokrich_Page_32thm.jpg
AR64 116426
comparisonofdiff00stokrich_Page_33.QC.jpg
AR65 48796
comparisonofdiff00stokrich_Page_33thm.jpg
AR66 108785
comparisonofdiff00stokrich_Page_34.QC.jpg
AR67 46706
comparisonofdiff00stokrich_Page_34thm.jpg
AR68 127717
comparisonofdiff00stokrich_Page_35.QC.jpg
AR69 50129
comparisonofdiff00stokrich_Page_35thm.jpg
AR70 96805
comparisonofdiff00stokrich_Page_36.QC.jpg
AR71 43301
comparisonofdiff00stokrich_Page_36thm.jpg
AR72 108500
comparisonofdiff00stokrich_Page_37.QC.jpg
AR73 45997
comparisonofdiff00stokrich_Page_37thm.jpg
AR74 94927
comparisonofdiff00stokrich_Page_38.QC.jpg
AR75 41993
comparisonofdiff00stokrich_Page_38thm.jpg
AR76 110061
comparisonofdiff00stokrich_Page_39.QC.jpg
AR77 47290
comparisonofdiff00stokrich_Page_39thm.jpg
AR78 116641
comparisonofdiff00stokrich_Page_40.QC.jpg
AR79 47560
comparisonofdiff00stokrich_Page_40thm.jpg
AR80 119651
comparisonofdiff00stokrich_Page_41.QC.jpg
AR81 48460
comparisonofdiff00stokrich_Page_41thm.jpg
AR82 111590
comparisonofdiff00stokrich_Page_42.QC.jpg
AR83 47057
comparisonofdiff00stokrich_Page_42thm.jpg
AR84 110192
comparisonofdiff00stokrich_Page_43.QC.jpg
AR85 45374
comparisonofdiff00stokrich_Page_43thm.jpg
AR86 104480
comparisonofdiff00stokrich_Page_44.QC.jpg
AR87 43406
comparisonofdiff00stokrich_Page_44thm.jpg
AR88 102694
comparisonofdiff00stokrich_Page_45.QC.jpg
AR89 43059
comparisonofdiff00stokrich_Page_45thm.jpg
AR90 109502
comparisonofdiff00stokrich_Page_46.QC.jpg
AR91 46115
comparisonofdiff00stokrich_Page_46thm.jpg
AR92 108971
comparisonofdiff00stokrich_Page_47.QC.jpg
AR93 46272
comparisonofdiff00stokrich_Page_47thm.jpg
AR94 118671
comparisonofdiff00stokrich_Page_48.QC.jpg
AR95 46875
comparisonofdiff00stokrich_Page_48thm.jpg
AR96 115136
comparisonofdiff00stokrich_Page_49.QC.jpg
AR97 47368
comparisonofdiff00stokrich_Page_49thm.jpg
AR98 82898
comparisonofdiff00stokrich_Page_50.QC.jpg
AR99 38475
comparisonofdiff00stokrich_Page_50thm.jpg
AR100 96912
comparisonofdiff00stokrich_Page_51.QC.jpg
AR101 42282
comparisonofdiff00stokrich_Page_51thm.jpg
AR102 112532
comparisonofdiff00stokrich_Page_52.QC.jpg
AR103 47836
comparisonofdiff00stokrich_Page_52thm.jpg
AR104 79086
comparisonofdiff00stokrich_Page_53.QC.jpg
AR105 38257
comparisonofdiff00stokrich_Page_53thm.jpg
AR106 86092
comparisonofdiff00stokrich_Page_54.QC.jpg
AR107 41164
comparisonofdiff00stokrich_Page_54thm.jpg
AR108 113521
comparisonofdiff00stokrich_Page_55.QC.jpg
AR109 47461
comparisonofdiff00stokrich_Page_55thm.jpg
AR110 79843
comparisonofdiff00stokrich_Page_56.QC.jpg
AR111 38189
comparisonofdiff00stokrich_Page_56thm.jpg
AR112 100084
comparisonofdiff00stokrich_Page_57.QC.jpg
AR113 43278
comparisonofdiff00stokrich_Page_57thm.jpg
AR114 90908
comparisonofdiff00stokrich_Page_58.QC.jpg
AR115 41821
comparisonofdiff00stokrich_Page_58thm.jpg
AR116 101200
comparisonofdiff00stokrich_Page_59.QC.jpg
AR117 44556
comparisonofdiff00stokrich_Page_59thm.jpg
AR118 94678
comparisonofdiff00stokrich_Page_60.QC.jpg
AR119 41500
comparisonofdiff00stokrich_Page_60thm.jpg
AR120 105958
comparisonofdiff00stokrich_Page_61.QC.jpg
AR121 45093
comparisonofdiff00stokrich_Page_61thm.jpg
AR122 117086
comparisonofdiff00stokrich_Page_62.QC.jpg
AR123 47674
comparisonofdiff00stokrich_Page_62thm.jpg
AR124 86891
comparisonofdiff00stokrich_Page_63.QC.jpg
AR125 38880
comparisonofdiff00stokrich_Page_63thm.jpg
AR126 97366
comparisonofdiff00stokrich_Page_64.QC.jpg
AR127 42728
comparisonofdiff00stokrich_Page_64thm.jpg
AR128 117029
comparisonofdiff00stokrich_Page_65.QC.jpg
AR129 48582
comparisonofdiff00stokrich_Page_65thm.jpg
AR130 125105
comparisonofdiff00stokrich_Page_66.QC.jpg
AR131 50029
comparisonofdiff00stokrich_Page_66thm.jpg
AR132 119591
comparisonofdiff00stokrich_Page_67.QC.jpg
AR133 48759
comparisonofdiff00stokrich_Page_67thm.jpg
AR134 112559
comparisonofdiff00stokrich_Page_68.QC.jpg
AR135 46805
comparisonofdiff00stokrich_Page_68thm.jpg
AR136 118214
comparisonofdiff00stokrich_Page_69.QC.jpg
AR137 48596
comparisonofdiff00stokrich_Page_69thm.jpg
AR138 115294
comparisonofdiff00stokrich_Page_70.QC.jpg
AR139 46933
comparisonofdiff00stokrich_Page_70thm.jpg
AR140 119512
comparisonofdiff00stokrich_Page_71.QC.jpg
AR141 48482
comparisonofdiff00stokrich_Page_71thm.jpg
AR142 115065
comparisonofdiff00stokrich_Page_72.QC.jpg
AR143 47310
comparisonofdiff00stokrich_Page_72thm.jpg
AR144 126710
comparisonofdiff00stokrich_Page_73.QC.jpg
AR145 50814
comparisonofdiff00stokrich_Page_73thm.jpg
AR146 103720
comparisonofdiff00stokrich_Page_74.QC.jpg
AR147 44779
comparisonofdiff00stokrich_Page_74thm.jpg
AR148 117083
comparisonofdiff00stokrich_Page_75.QC.jpg
AR149 47932
comparisonofdiff00stokrich_Page_75thm.jpg
AR150 114055
comparisonofdiff00stokrich_Page_76.QC.jpg
AR151
comparisonofdiff00stokrich_Page_76thm.jpg
AR152 119507
comparisonofdiff00stokrich_Page_77.QC.jpg
AR153 48755
comparisonofdiff00stokrich_Page_77thm.jpg
AR154 57373
comparisonofdiff00stokrich_Page_78.QC.jpg
AR155 30412
comparisonofdiff00stokrich_Page_78thm.jpg
AR156 103307
comparisonofdiff00stokrich_Page_79.QC.jpg
AR157 43798
comparisonofdiff00stokrich_Page_79thm.jpg
AR158 102368
comparisonofdiff00stokrich_Page_80.QC.jpg
AR159 43427
comparisonofdiff00stokrich_Page_80thm.jpg
AR160 102885
comparisonofdiff00stokrich_Page_81.QC.jpg
AR161 44488
comparisonofdiff00stokrich_Page_81thm.jpg
AR162 26065
comparisonofdiff00stokrich_Page_82.QC.jpg
AR163 21981
comparisonofdiff00stokrich_Page_82thm.jpg
AR164 89112
comparisonofdiff00stokrich_Page_83.QC.jpg
AR165 41183
comparisonofdiff00stokrich_Page_83thm.jpg
AR166 112790
comparisonofdiff00stokrich_Page_84.QC.jpg
AR167 46185
comparisonofdiff00stokrich_Page_84thm.jpg
AR168 66878
comparisonofdiff00stokrich_Page_85.QC.jpg
AR169 33868
comparisonofdiff00stokrich_Page_85thm.jpg
AR170 48413
comparisonofdiff00stokrich_Page_86.QC.jpg
AR171 29464
comparisonofdiff00stokrich_Page_86thm.jpg
AR172 105248
comparisonofdiff00stokrich_Page_87.QC.jpg
AR173 44015
comparisonofdiff00stokrich_Page_87thm.jpg
AR174 115934
comparisonofdiff00stokrich_Page_88.QC.jpg
AR175 47990
comparisonofdiff00stokrich_Page_88thm.jpg
AR176 117022
comparisonofdiff00stokrich_Page_89.QC.jpg
AR177 46652
comparisonofdiff00stokrich_Page_89thm.jpg
AR178 110975
comparisonofdiff00stokrich_Page_90.QC.jpg
AR179 45675
comparisonofdiff00stokrich_Page_90thm.jpg
AR180 126872
comparisonofdiff00stokrich_Page_91.QC.jpg
AR181 51866
comparisonofdiff00stokrich_Page_91thm.jpg
AR182 78820
comparisonofdiff00stokrich_Page_92.QC.jpg
AR183 36783
comparisonofdiff00stokrich_Page_92thm.jpg
AR184 102356
comparisonofdiff00stokrich_Page_93.QC.jpg
AR185 44205
comparisonofdiff00stokrich_Page_93thm.jpg
AR186 72443
comparisonofdiff00stokrich_Page_94.QC.jpg
AR187 36438
comparisonofdiff00stokrich_Page_94thm.jpg
AR188 120190
UF00097813_00001.mets
METS:structMap STRUCT1 mixed
METS:div DMDID ORDER 0 main
D1 1 Main
P1 Page i
METS:fptr
P2 i-a 2
P3 ii 3
P4 iii 4
P5 iv 5
P6 v 6
P7 7
P8 8
P9 9
P10 10
P11 11
P12 12
P13 13
P14 14
P15 15
P16 16
P17 17
P18 18
P19 19
P20 20
P21 21
P22 22
P23 23
P24 24
P25 25
P26 26
P27 27
P28 28
P29 29
P30 30
P31 31
P32 32
P33 33
P34 34
P35 35
P36 36
P37 37
P38 38
P39 39
P40 40
P41 41
P42 42
P43 43
P44 44
P45 45
P46 46
P47 47
P48 48
P49 49
P50 50
P51 51
P52 52
P53 53
P54 54
P55 55
P56 56
P57 57
P58 58
P59 59
P60 60
P61 61
P62 62
P63 63
P64 64
P65 65
P66 66
P67 67
P68 68
P69 69
P70 70
P71 71
P72 72
P73 73
P74 74
P75 75
P76 76
P77 77
P78 78
P79 79
P80 80
P81 81
P82 82
P83
P84 84
P85 85
P86 86
P87 87
P88 88
P89 89
P90 90
P91 91
P92 92
P93 93
P94 94
METS:behaviorSec VIEWS Options available to user for viewing this item
METS:behavior VIEW1 STRUCTID Default View
METS:mechanism Viewer JPEGs Procedure xlink:type simple xlink:title JPEG_Viewer()
VIEW2 Alternate
zoomable JPEG2000s JP2_Viewer()
VIEW3
Related image viewer shows thumbnails each Related_Image_Viewer()
INTERFACES Banners or interfaces which resource can appear under
INT1 Interface
UFDC_Interface_Loader